Basic Information
| Provider Information | |||||||||
| NPI: | 1174132153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAINELLE MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 MEDICAL CENTER DR | ||||||||
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| City: | RAINELLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259621064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044386188 | ||||||||
| FaxNumber: | 3044386819 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 MALL RD | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244262413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044386188 | ||||||||
| FaxNumber: | 3044386819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDSON-BENNETT | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3044386188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.