| Community Care Of West Virginia, Inc. | |
|
100 Market Pl Bridgeport WV 26330-9168 | |
| (304) 848-5770 | |
| (304) 848-0890 |
| Full Name | Community Care Of West Virginia, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Market Pl, Bridgeport, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
| Authorized Official Contact | 3045872541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Of West Virginia, Inc. 100 Market Pl Bridgeport WV 26330-9168 Ph: (304) 848-5770 | Community Care Of West Virginia, Inc. 100 Market Pl Bridgeport WV 26330-9168 Ph: (304) 848-5770 |
| NPI Number | 1063808418 |
|---|---|
| Provider Enumeration Date | 04/13/2015 |
| Last Update Date | 04/26/2024 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20150605000921 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063808418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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