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NPI Code Detail

MEDICARE: ST. GEORGE MEDICAL CLINIC INC.

MEDICARE: ST. GEORGE MEDICAL CLINIC INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497853600
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. GEORGE MEDICAL CLINIC INC.
Provider Business Mailing Address
First Line : 8591 HOLLY MEADOWS RD
Second Line :
City : PARSONS
State : WV
Zip : 26287-8604
Country : US
Telephone Number : 304-478-3339
Fax Number : 304-478-3311
Provider Business Practice Location Address
First Line : 8591 HOLLY MEADOWS RD
Second Line :
City : PARSONS
State : WV
Zip : 26287-8604
Country : US
Telephone Number : 304-478-3339
Fax Number : 304-478-3311
Authorized Official
Title or Position : CEO
Name : MR. PAUL WAMSLEY JR.
Credential :
Telephone Number : 304-478-3339
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/22/2014

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