Provider Demographics
NPI:1437214509
Name:CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
Other - Org Name:COMMUNITY HEALTH CENTER OF NE WETZEL COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-432-8211
Mailing Address - Street 1:60 MAY LN
Mailing Address - Street 2:STE 102
Mailing Address - City:BURTON
Mailing Address - State:WV
Mailing Address - Zip Code:26562-9669
Mailing Address - Country:US
Mailing Address - Phone:304-775-4671
Mailing Address - Fax:304-775-4211
Practice Address - Street 1:1855 HORNET HWY
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:WV
Practice Address - Zip Code:26562-7430
Practice Address - Country:US
Practice Address - Phone:304-775-4671
Practice Address - Fax:304-775-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCN0274OtherMEDICARE RR
WV0035288001Medicaid
WV001990226OtherMS BCBS
CN0274OtherRAILROAD MEDICARE
WV9171181Medicare PIN
WV511838Medicare Oscar/Certification
CN0274OtherRAILROAD MEDICARE
WV0035288001Medicaid