Provider Demographics
NPI:1902985914
Name:HARNED MEMORIAL MEDICAL CLINIC INC
Entity type:Organization
Organization Name:HARNED MEMORIAL MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARNED
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAFP PHD
Authorized Official - Phone:304-379-2114
Mailing Address - Street 1:ONE MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525
Mailing Address - Country:US
Mailing Address - Phone:304-379-2114
Mailing Address - Fax:304-379-7929
Practice Address - Street 1:ONE MEMORIAL DRIVE
Practice Address - Street 2:RT 26 NORTH
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525
Practice Address - Country:US
Practice Address - Phone:304-379-2114
Practice Address - Fax:304-379-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034502000Medicaid
SLF000Medicare UPIN
513858Medicare ID - Type UnspecifiedRURAL HEALTH