MEDICARE: CABIN CREEK HEALTH CENTER, 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)	1041-6374	WV

General Provider Information

NPI Number	:	1821377292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABIN CREEK HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	DAWES
State	:	WV
Zip	:	25054-0070
Country	:	US
Telephone Number	:	304-734-2040
Fax Number	:	304-734-2047

Provider Business Practice Location Address
First Line	:	1ST & BRANNON STREET
Second Line	:
City	:	EAST BANK
State	:	WV
Zip	:	25067-9752
Country	:	US
Telephone Number	:	304-595-5068
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CRAIG ROBINSON
Credential	:	MPH
Telephone Number	:	304-734-2040

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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