MEDICARE: PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED

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)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	581043	OTHER	WV	MEDICARE
2	P793	OTHER	WV	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871365304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED

Provider Business Mailing Address
First Line	:	25 W BLUEMONT ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1242
Country	:	US
Telephone Number	:	304-265-0312
Fax Number	:	304-265-0314

Provider Business Practice Location Address
First Line	:	216 LINCOLN ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1442
Country	:	US
Telephone Number	:	304-265-1851
Fax Number	:	304-265-0028

Authorized Official
Title or Position	:	CEO
Name	:	ELIZABETH J GRIFFITH
Credential	:
Telephone Number	:	304-265-0312

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	08/07/2024

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Directions to “PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED ” Practice Location

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