Healthcare Provider Details

I. General information

NPI: 1992813604
Provider Name (Legal Business Name): PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
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: 304-265-4909
  • Fax: 304-265-4915
Mailing address:
  • Phone: 304-265-0312
  • Fax: 304-265-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY J. SNYDER
Title or Position: EXECUTIVE ASSISTANT/ACCESS MANAGER
Credential:
Phone: 304-265-0312