| Community Care Of West Virginia, Inc. | |
|
122 Center St Clay WV 25043-7046 | |
| (304) 587-7301 | |
| (304) 587-2594 |
| Full Name | Community Care Of West Virginia, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 Center St, Clay, 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 147 Clay WV 25043-0147 Ph: (304) 587-7301 | Community Care Of West Virginia, Inc. 122 Center St Clay WV 25043-7046 Ph: (304) 587-7301 |
| NPI Number | 1073562641 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 01/19/2024 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20120904000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073562641 | NPI | - | NPPES |
| 0035189000 | Medicaid | WV | |
| 001709907 | Other | WV | MS BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1038-3999 (West Virginia) | Primary |
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