| Wv Family Medicine,inc | |
|
1115 2nd Ave West Logan WV 25601-3309 | |
| (304) 831-0085 | |
| (304) 831-0088 |
| Full Name | Wv Family Medicine,inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1115 2nd Ave, West Logan, West Virginia |
| Authorized Official Name and Position | Karunasree Kanuri (PRESIDENT) |
| Authorized Official Contact | 3048310085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wv Family Medicine,inc 1115 2nd Ave West Logan WV 25601-3309 Ph: (304) 831-0085 | Wv Family Medicine,inc 1115 2nd Ave West Logan WV 25601-3309 Ph: (304) 831-0085 |
| NPI Number | 1528284247 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3274550082 |
|---|---|
| Medicare Enrollment ID | O20051101000117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528284247 | NPI | - | NPPES |
| 3810003597 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 22060 (West Virginia) | Primary |
| Provider Name | Karunasree Kanuri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174612907 PECOS PAC ID: 8820034028 Enrollment ID: I20051102000164 |
Legacy Family Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1113 2nd Ave, West Logan, WV 25601 Phone: 304-752-1900 Fax: 304-752-0188 |