MEDICARE: HARNED MEMORIAL 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
1	207Q00000X	Family Medicine Physician

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	:	1902985914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARNED MEMORIAL MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	ONE MEMORIAL DRIVE
Second Line	:
City	:	BRUCETON MILLS
State	:	WV
Zip	:	26525
Country	:	US
Telephone Number	:	304-379-2114
Fax Number	:	304-379-7929

Provider Business Practice Location Address
First Line	:	ONE MEMORIAL DRIVE
Second Line	:	RT 26 NORTH
City	:	BRUCETON MILLS
State	:	WV
Zip	:	26525
Country	:	US
Telephone Number	:	304-379-2114
Fax Number	:	304-379-7929

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MAX A HARNED
Credential	:	MD FAAFP PHD
Telephone Number	:	304-379-2114

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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