Provider Demographics
NPI:1396852984
Name:RALEIGH HEART CLINIC INC
Entity Type:Organization
Organization Name:RALEIGH HEART CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARGHOUTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-254-0892
Mailing Address - Street 1:304 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-254-0892
Mailing Address - Fax:304-254-0893
Practice Address - Street 1:304 CARRIAGE DR
Practice Address - Street 2:RALEIGH HEART CLINIC INC
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-254-0892
Practice Address - Fax:304-254-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16708207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801019000Medicaid
WV1801019000Medicaid
9343601Medicare ID - Type Unspecified