MEDICARE: PRESTON-TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED

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
1	261QF0400X	Federally Qualified Health Center (FQHC)	1039-5432	WV

Other Identifiers

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

General Provider Information

NPI Number	:	1548615305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTON-TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED

Provider Business Mailing Address
First Line	:	P.O. BOX 399
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1270
Country	:	US
Telephone Number	:	304-265-0312
Fax Number	:	304-265-0314

Provider Business Practice Location Address
First Line	:	711 N PIKE ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1221
Country	:	US
Telephone Number	:	304-265-4600
Fax Number	:	304-265-6008

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. LINDA M. SHRIVER
Credential	:
Telephone Number	:	304-265-0312

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	04/29/2016

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