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)

Other Identifiers

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

General Provider Information

NPI Number	:	1992813604
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	:	725 NORTH PIKE STREET
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1270
Country	:	US
Telephone Number	:	304-265-4909
Fax Number	:	304-265-4915

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT/ACCESS MANAGER
Name	:	BEVERLY J. SNYDER
Credential	:
Telephone Number	:	304-265-0312

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/15/2022

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