Provider Demographics
NPI:1700819471
Name:PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Entity Type:Organization
Organization Name:PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Other - Org Name:MT. STORM HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT/ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-265-0312
Mailing Address - Street 1:25 W BLUEMONT ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1242
Mailing Address - Country:US
Mailing Address - Phone:304-265-0312
Mailing Address - Fax:304-265-0314
Practice Address - Street 1:14311 GEORGE WASHINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MT. STORM
Practice Address - State:WV
Practice Address - Zip Code:26739-0077
Practice Address - Country:US
Practice Address - Phone:304-693-7616
Practice Address - Fax:304-693-7776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTON TAYLOR COMMUNITY HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007992Medicaid
WV5119091Medicare PIN
WVCC5112Medicare PIN
WV3810007992Medicaid