Provider Demographics
NPI:1356851588
Name:RITCHIE COUNTY PRIMARY CARE ASSOC INC
Entity Type:Organization
Organization Name:RITCHIE COUNTY PRIMARY CARE ASSOC INC
Other - Org Name:RITCHIE REGIONAL HEALTH CENTER-DODDRIDGE HIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-643-4005
Mailing Address - Street 1:L-4162
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:304-643-4005
Mailing Address - Fax:304-643-4007
Practice Address - Street 1:79 BULLDOG DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-8000
Practice Address - Country:US
Practice Address - Phone:304-643-4005
Practice Address - Fax:304-643-4007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RITCHIE COUNTY PRIMARY CARE ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)