Organization
PENDLETON COMMUNITY CARE, INC.
Active
Other names
North Fork Primary Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE HUDSON (CEO)
(304) 358-7230
Entity
Organization
Contact information
Practice address
16921 MOUNTAINEER DRIVE, RIVERTON, WV 26814-0101
(304) 567-2101
(304) 567-2102
Mailing address
PO BOX 101, RIVERTON, WV 26814-0101
(304) 567-2101
(304) 567-2102
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
51D0661868
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006211
—
WV
Enumeration date
06/04/2007
Last updated
07/19/2016
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