Organization
ST. ALBANS INTEGRATIVE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUDOLPH MICHAEL KEVAK JR. M.D. (OWNER)
(304) 201-3600
Entity
Organization
Contact information
Practice address
200 MAIN ST, SAINT ALBANS, WV 25177-2802
(304) 201-3600
(304) 201-2368
Mailing address
552 BOX, ST. ALBANS, WV 25177
(304) 201-3600
(304) 201-2368
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
18688
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5600010000
—
WV
Enumeration date
05/10/2011
Last updated
05/10/2011
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