Provider Demographics
NPI:1174686463
Name:FAMILY HEALTH ASSOCIATES OF THE KANAWHA VALLEY, PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH ASSOCIATES OF THE KANAWHA VALLEY, PLLC
Other - Org Name:FAMILY HEALTH ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DETEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-3555
Mailing Address - Street 1:509 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1310
Mailing Address - Country:US
Mailing Address - Phone:304-720-3555
Mailing Address - Fax:304-720-3556
Practice Address - Street 1:509 2ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1310
Practice Address - Country:US
Practice Address - Phone:304-720-3555
Practice Address - Fax:304-720-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0206415000Medicaid
WV0206415000Medicaid