Provider Demographics
NPI:1033299862
Name:MOUNTAINEER COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MOUNTAINEER COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-947-5500
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:783 WINCHESTER ST
Mailing Address - City:PAW PAW
Mailing Address - State:WV
Mailing Address - Zip Code:25434-0002
Mailing Address - Country:US
Mailing Address - Phone:304-947-5500
Mailing Address - Fax:304-947-5563
Practice Address - Street 1:783 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:WV
Practice Address - Zip Code:25434-0002
Practice Address - Country:US
Practice Address - Phone:304-947-5500
Practice Address - Fax:304-947-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCC5660OtherRRMC
WV0035343000Medicaid
WV0035343000Medicaid