| Pendleton Community Care, Inc. | |
|
16921 Mountaineer Drive Riverton WV 26814-0101 | |
| (304) 567-2101 | |
| (304) 567-2102 |
| Full Name | Pendleton Community Care, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 16921 Mountaineer Drive, Riverton, West Virginia |
| Authorized Official Name and Position | Jamie M Hudson (CEO) |
| Authorized Official Contact | 3043587230 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pendleton Community Care, Inc. Po Box 101 Riverton WV 26814-0101 Ph: (304) 567-2101 | Pendleton Community Care, Inc. 16921 Mountaineer Drive Riverton WV 26814-0101 Ph: (304) 567-2101 |
| NPI Number | 1417931379 |
|---|---|
| Provider Enumeration Date | 12/05/2005 |
| Last Update Date | 07/19/2016 |
| Medicare PECOS PAC ID | 3678470614 |
|---|---|
| Medicare Enrollment ID | O20050211000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417931379 | NPI | - | NPPES |
| 001706795 | Other | WV | MS BCBS |
| 5369042000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |