Provider Demographics
NPI:1073503637
Name:PRIME HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:PRIME HEALTH ASSOCIATES
Other - Org Name:BEAVER FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZINZUWADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-1300
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-0550
Mailing Address - Country:US
Mailing Address - Phone:304-255-1300
Mailing Address - Fax:304-255-5391
Practice Address - Street 1:703 RITTER DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-255-1300
Practice Address - Fax:304-255-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDA4369OtherRR MEDICARE GROUP NUMBER
WV0207791000Medicaid
WV0207791000Medicaid