| Community Care Of West Virginia, Inc. | |
|
1302 Buckhannon Pike Nutter Fort WV 26301-4406 | |
| (304) 326-7501 | |
| (304) 624-3259 |
| Full Name | Community Care Of West Virginia, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1302 Buckhannon Pike, Nutter Fort, 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. Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | Community Care Of West Virginia, Inc. 1302 Buckhannon Pike Nutter Fort WV 26301-4406 Ph: (304) 326-7501 |
| NPI Number | 1477992915 |
|---|---|
| Provider Enumeration Date | 06/18/2013 |
| Last Update Date | 06/18/2013 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20131028001769 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477992915 | NPI | - | NPPES |
| 2287-4957 | Other | WV | BURSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2287-4967 (West Virginia) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1302 Buckhannon Pike, Nutter Fort, WV 26301 Phone: 304-624-3275 Fax: 304-624-3382 |