Provider Demographics
NPI:1326328006
Name:SAINT ALBANS INTEGRATIVE HEALTH CENTER INC
Entity Type:Organization
Organization Name:SAINT ALBANS INTEGRATIVE HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KEVAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-201-3600
Mailing Address - Street 1:201 6TH AVE
Mailing Address - Street 2:PO BOX 552
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2836
Mailing Address - Country:US
Mailing Address - Phone:304-201-3600
Mailing Address - Fax:304-201-2368
Practice Address - Street 1:201 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2836
Practice Address - Country:US
Practice Address - Phone:304-201-3600
Practice Address - Fax:304-201-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1417249459Medicare NSC