Provider Demographics
NPI:1629214200
Name:CORE HEALTH CARE
Entity Type:Organization
Organization Name:CORE HEALTH CARE
Other - Org Name:CORE HEALTH CARE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-879-5025
Mailing Address - Street 1:1929 MASON DIXON HWY
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-8152
Mailing Address - Country:US
Mailing Address - Phone:304-879-5025
Mailing Address - Fax:304-879-4105
Practice Address - Street 1:1929 MASON DIXON HWY
Practice Address - Street 2:
Practice Address - City:MAIDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26541-8152
Practice Address - Country:US
Practice Address - Phone:304-879-5025
Practice Address - Fax:304-879-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12054207R00000X
WV43007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty