Provider Demographics
NPI:1730635863
Name:WILLOW CREEK HEALTH CLINIC INC
Entity Type:Organization
Organization Name:WILLOW CREEK HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:ADDAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP
Authorized Official - Phone:304-436-8323
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:PREMIER
Mailing Address - State:WV
Mailing Address - Zip Code:24878-0219
Mailing Address - Country:US
Mailing Address - Phone:304-436-8323
Mailing Address - Fax:
Practice Address - Street 1:15237 COAL HERITAGE ROAD/US-52 NORTH
Practice Address - Street 2:HONEYCAMP /247
Practice Address - City:RODERFIELD
Practice Address - State:WV
Practice Address - Zip Code:24881
Practice Address - Country:US
Practice Address - Phone:304-436-8323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42727261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care