Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Community Care Pediatrics of Buckhannon
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
RICHARD G SIMON (CEO)
(304) 545-0571
Entity
Organization
Contact information
Practice address
4 NORTHRIDGE DR STE 118, BUCKHANNON, WV 26201-8484
(304) 473-5660
(304) 473-5661
Mailing address
4 NORTHRIDGE DR STE 118, BUCKHANNON, WV 26201-8484
(304) 473-5660
(304) 473-5661
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255507810
—
WV
Enumeration date
05/05/2008
Last updated
01/19/2024
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