| Proactive Md Wv Corporation | |
|
269 Staunton Avenue Sw Suite 100 S. Charleston WV 25303 | |
| (304) 768-0321 | |
| (864) 990-3834 |
| Full Name | Proactive Md Wv Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 269 Staunton Avenue Sw, S. Charleston, West Virginia |
| Authorized Official Name and Position | Mark Kemble (CMO) |
| Authorized Official Contact | 8645010754 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Md Wv Corporation 124 Allawood Ct Simpsonville SC 29681-6207 Ph: (864) 501-0754 | Proactive Md Wv Corporation 269 Staunton Avenue Sw Suite 100 S. Charleston WV 25303 Ph: (304) 768-0321 |
| NPI Number | 1275379810 |
|---|---|
| Provider Enumeration Date | 07/03/2024 |
| Last Update Date | 04/03/2025 |
| Medicare PECOS PAC ID | 1850816802 |
|---|---|
| Medicare Enrollment ID | O20250422003378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275379810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lisa Newell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720071194 PECOS PAC ID: 0840109104 Enrollment ID: I20071211000398 |
| Provider Name | Laura Cogan Cunnings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841700440 PECOS PAC ID: 2264776186 Enrollment ID: I20181204002527 |
| Provider Name | James William Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144285354 PECOS PAC ID: 8527065002 Enrollment ID: I20250429002687 |
| Provider Name | Maureen Wellman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316589039 PECOS PAC ID: 0345766648 Enrollment ID: I20250430000156 |