Healthcare Provider Details

I. General information

NPI: 1699845420
Provider Name (Legal Business Name): PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH PIKE STREET
GRAFTON WV
26354-1270
US

IV. Provider business mailing address

25 W BLUEMONT ST
GRAFTON WV
26354-1242
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0312
  • Fax: 304-265-0314
Mailing address:
  • Phone: 304-265-0312
  • Fax: 304-265-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH J. GRIFFITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 304-265-0312