| Princeton Family Medicine, Pllc | |
|
904 Harrison St Princeton WV 24740-3011 | |
| (304) 431-7100 | |
| (304) 431-7112 |
| Full Name | Princeton Family Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 904 Harrison St, Princeton, West Virginia |
| Authorized Official Name and Position | Ryan T. Runyon (PHYSICIAN, OWNER) |
| Authorized Official Contact | 3044317100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Princeton Family Medicine, Pllc Po Box 1589 Princeton WV 24740-1589 Ph: (304) 431-7100 | Princeton Family Medicine, Pllc 904 Harrison St Princeton WV 24740-3011 Ph: (304) 431-7100 |
| NPI Number | 1154435881 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6103829767 |
|---|---|
| Medicare Enrollment ID | O20060821000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154435881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2005 (West Virginia) | Primary |
| Provider Name | Ryan T Runyon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932115938 PECOS PAC ID: 4688636756 Enrollment ID: I20041101000537 |
| Provider Name | Pamela Shrader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932942646 PECOS PAC ID: 4789125162 Enrollment ID: I20240925002984 |
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