Organization
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Active
Organization
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Active
Parent organization
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Other names
RiverValley Health & Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Authorized official
MRS. VICKI L KNICELY (BILLING SUPERVISOR CREDENTIALING)
(304) 275-3301
Entity
Organization
Contact information
Practice address
606 WASHINGTON STREET, RAVENSWOOD, WV 26164
(304) 273-1033
(304) 273-1034
Mailing address
606 WASHINGTON STREET, RAVENSWOOD, WV 26164
(304) 273-1033
(304) 273-1034
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009486002
—
WV
Enumeration date
12/14/2006
Last updated
01/03/2014
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