Basic Information
| Provider Information | |||||||||
| NPI: | 1982825428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RATLIFF | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | L, | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VANCE | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 176 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | RAINELLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259621064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044386188 | ||||||||
| FaxNumber: | 3044386188 | ||||||||
| Practice Location | |||||||||
| Address1: | 289 DAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249019674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047930005 | ||||||||
| FaxNumber: | 5402834470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2127 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 2127 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 9054416 | 01 | WV | AETNA | OTHER | 2122486 | 01 | WV | HIGHMARK BLUE CROSS BLUE SHIELD | OTHER | 3810016079 | 05 | WV | MEDICAID |