MEDICARE: HEDGESVILLE HEALTHCARE CENTER PLLC

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	261QP2300X	Primary Care Clinic/Center	23659	WV

General Provider Information

NPI Number	:	1205268414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEDGESVILLE HEALTHCARE CENTER PLLC

Provider Business Mailing Address
First Line	:	3790 HEDGESVILLE RD STE H
Second Line	:
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6704
Country	:	US
Telephone Number	:	304-754-7160
Fax Number	:	304-754-7244

Provider Business Practice Location Address
First Line	:	3790 HEDGESVILLE RD STE H
Second Line	:
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6704
Country	:	US
Telephone Number	:	304-754-7160
Fax Number	:	304-754-7244

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. JUSTIN GLASSFORD
Credential	:	MD
Telephone Number	:	304-754-7160

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	07/30/2013

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