| Southern West Virginia Health System- | |
|
1563 Sand Plant Rd South Charleston WV 25309-6120 | |
| (304) 756-1500 | |
| (304) 756-1549 |
| Full Name | Southern West Virginia Health System- |
|---|---|
| Speciality | Clinic/Center |
| Location | 1563 Sand Plant Rd, South Charleston, West Virginia |
| Authorized Official Name and Position | Lisa Leach (CEO) |
| Authorized Official Contact | 3048245806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern West Virginia Health System- 7400 Lynn Ave Hamlin WV 25523-1138 Ph: (304) 824-5806 | Southern West Virginia Health System- 1563 Sand Plant Rd South Charleston WV 25309-6120 Ph: (304) 756-1500 |
| NPI Number | 1457610594 |
|---|---|
| Provider Enumeration Date | 05/10/2012 |
| Last Update Date | 03/08/2023 |
| Medicare PECOS PAC ID | 6204821879 |
|---|---|
| Medicare Enrollment ID | O20120716000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457610594 | NPI | - | NPPES |
| 3810025805 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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