Provider Demographics
NPI:1851474845
Name:HILL, CHARLES E JR (PAC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HILL
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:FAMILY HEALTHCARE ASSOC INC
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874
Mailing Address - Country:US
Mailing Address - Phone:304-732-6735
Mailing Address - Fax:304-732-9218
Practice Address - Street 1:1650 MAIN STREET
Practice Address - Street 2:FAMILY HEALTHCARE ASSOC INC
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874
Practice Address - Country:US
Practice Address - Phone:304-732-6735
Practice Address - Fax:304-732-9218
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000490Medicaid
WV3810000490Medicaid