Organization
WOMENCARE, INC
Active
Other names
FAMILYCARE HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE DIANNE RAY (CREDENTIALING SPECIALIST)
(304) 757-6999
Entity
Organization
Contact information
Practice address
300 ROOSEVELT BLVD, ELEANOR, WV 25070-0000
(304) 380-7728
(304) 586-1301
Mailing address
301 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9552
(304) 757-6999
(304) 757-3252
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511022
PART A PTAN
—
01
—
D204
PART B PTAN
—
Enumeration date
08/01/2013
Last updated
05/24/2022
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