Provider Demographics
NPI:1497781520
Name:OHIO VALLEY MEDICAL QUICKCARE INC
Entity Type:Organization
Organization Name:OHIO VALLEY MEDICAL QUICKCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-485-2700
Mailing Address - Street 1:417 GRAND PARK
Mailing Address - Street 2:STE 103
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105
Mailing Address - Country:US
Mailing Address - Phone:304-485-2700
Mailing Address - Fax:304-485-0481
Practice Address - Street 1:517 36TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101
Practice Address - Country:US
Practice Address - Phone:304-485-1044
Practice Address - Fax:304-482-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0019701003Medicaid
OH2208891Medicaid
OH0019701002Medicaid
WV2242433Medicaid
WV2242433Medicaid
WV0019701003Medicaid