Provider Demographics
NPI:1699027714
Name:EASTERN DIV-RANSON URGENT CARE
Entity Type:Organization
Organization Name:EASTERN DIV-RANSON URGENT CARE
Other - Org Name:UNIVERSITY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-285-7101
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-285-7100
Mailing Address - Fax:304-285-7126
Practice Address - Street 1:203 EAST FOURTH AVENUE SUITE B
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1617
Practice Address - Country:US
Practice Address - Phone:304-725-2273
Practice Address - Fax:304-725-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9121131Medicare UPIN