Basic Information
| Provider Information | |||||||||
| NPI: | 1013313816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW RIVER HEALTH ASSOCIATION, INC | ||||||||
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| OtherOrganizationName: | NEW RIVER HEALTH WOMENS HLT & FP MEDICAID | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | 908 SCARBRO ROAD | ||||||||
| City: | SCARBRO | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259170337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044693345 | ||||||||
| FaxNumber: | 3044692981 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 SUTPHIN LN | ||||||||
| Address2: | |||||||||
| City: | SCARBRO | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259178817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044693345 | ||||||||
| FaxNumber: | 3044692981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHULTZ | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3044692905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0050X | 1036-9138 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0021725000 | 05 | WV | MEDICAID |