Provider Demographics
NPI:1699830752
Name:CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
Other - Org Name:CLAY-BATTELLE COMMUNITY HEALTH CENTER
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:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521-0072
Mailing Address - Country:US
Mailing Address - Phone:304-432-8211
Mailing Address - Fax:304-432-8213
Practice Address - Street 1:5861 MASON DIXON HWY
Practice Address - Street 2:
Practice Address - City:BLACKSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26521
Practice Address - Country:US
Practice Address - Phone:304-432-8211
Practice Address - Fax:304-432-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035288000Medicaid
CN0274OtherRAILROAD MEDICARE
WVCN0274OtherRR MC
WV001709531OtherMS BCBS
WV511833Medicare Oscar/Certification
511833Medicare Oscar/Certification
CN0274OtherRAILROAD MEDICARE
9277731Medicare PIN