MEDICARE: PRESTON-TAYLOR COMMUNITY HEALTH CENTERS 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1649265455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INC

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:	PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INC
City	:	GRAFTON
State	:	WV
Zip	:	26354-0399
Country	:	US
Telephone Number	:	304-265-0312
Fax Number	:	304-265-0314

Provider Business Practice Location Address
First Line	:	725 N PIKE ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1270
Country	:	US
Telephone Number	:	304-265-4909
Fax Number	:	304-265-4916

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LINDA M SHRIVER
Credential	:
Telephone Number	:	304-265-0312

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

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