Provider Demographics
NPI:1144218694
Name:OHIO VALLEY MEDICAL QUICKCARE INC
Entity Type:Organization
Organization Name:OHIO VALLEY MEDICAL QUICKCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-485-2700
Mailing Address - Street 1:417 GRAND PARK DR
Mailing Address - Street 2:STE 103
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4049
Mailing Address - Country:US
Mailing Address - Phone:304-485-2700
Mailing Address - Fax:304-485-0481
Practice Address - Street 1:324 PIKE ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3323
Practice Address - Country:US
Practice Address - Phone:740-374-4540
Practice Address - Fax:740-374-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208891Medicaid
WV0019701003Medicaid
OH9921162Medicare ID - Type Unspecified
WV9921161Medicare ID - Type Unspecified