Organization · Type 2 NPI

Community Care of West Virginia, Inc.

Federally Qualified Health Center (FQHC) · Ivydale, WV

NPI number 1992754592 Active

Practice location

797 Clinic Dr
Ivydale, WV 25113-8263

Call (304) 286-4200 Map

Fax (304) 286-2107

Mailing address

PO Box 147
Clay, WV 25043-0147

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	550630765002 (WV)

Federally Qualified Health Center (FQHC): Definition to come...

4 other providers at this address

NPI record

NPI: 1992754592
Entity type: Organization (Type 2)
Issued: May 9, 2006
Last updated: Jan 19, 2024
Status: Active
Subpart: Yes of Community Care of West Virginia, Inc.

Other names

<unavail>
Community Care of Big Otter · doing business as

Authorized official

Dora L Potasnik
Credentialing
(304) 587-2541

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1992754592

Community Care of West Virginia, Inc.'s National Provider Identifier is 1992754592, issued on May 9, 2006. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Ivydale, WV. The record was last updated on Jan 19, 2024.