=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699845420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 NORTH PIKE STREET
-----------------------------------------------------
City | GRAFTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26354-1270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-265-0312
-----------------------------------------------------
Fax | 304-265-0314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 W BLUEMONT ST
-----------------------------------------------------
City | GRAFTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26354-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-265-0312
-----------------------------------------------------
Fax | 304-265-0314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. ELIZABETH J. GRIFFITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-265-0312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------