Provider Demographics
NPI:1598849333
Name:BRAXTON HEALTH ASSOCIATES, INC
Entity Type:Organization
Organization Name:BRAXTON HEALTH ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:GIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-364-8941
Mailing Address - Street 1:617 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1137
Mailing Address - Country:US
Mailing Address - Phone:304-364-8941
Mailing Address - Fax:304-364-8943
Practice Address - Street 1:617 RIVER ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1137
Practice Address - Country:US
Practice Address - Phone:304-364-8941
Practice Address - Fax:304-364-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034606000Medicaid
WV0034606000Medicaid