Jack Eastwood
Individual provider Active NPI Community Health Worker · Poca, WV
NPI 1245804632 · NPPES record last updated May 19, 2021
Key facts
- NPI
- 1245804632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 75 Chris Dr
Poca, WV 25159-9033 - Phone
- (304) 759-9006
- NPI assigned
- May 19, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
75 Chris Dr
Poca, WV 25159-9033
Mailing address
75 Chris Dr
Poca, WV 25159-9033
Other providers in Poca, WV
- Leeanna Cunningham
- Lacey Nicole Dingus
- Jacque Michelle Dolin
- Melonie Sue Dolin
- William M. Easter
- Valery Eastwood
- Chasity Nicole Foster
- Rebecca Frampton
- Jessica R Fry
- Sami M Ghareeb
All providers in Poca, WV · Community Health Worker in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.