Provider Demographics
NPI:1417316415
Name:CHH MERRITTS CREEK FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:CHH MERRITTS CREEK FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REFERRAL CLERK/RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-399-6833
Mailing Address - Street 1:100 MEADOW POINTE
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-9209
Mailing Address - Country:US
Mailing Address - Phone:304-399-6833
Mailing Address - Fax:304-399-2987
Practice Address - Street 1:100 MEADOW POINTE
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9209
Practice Address - Country:US
Practice Address - Phone:304-399-6833
Practice Address - Fax:304-399-2987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABELL HUNTINGTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 19564302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1803384000Medicaid
WV1803384000Medicaid