Provider Demographics
NPI:1861494528
Name:ROANE COUNTY FAMILY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ROANE COUNTY FAMILY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-927-8177
Mailing Address - Street 1:146 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1826
Mailing Address - Country:US
Mailing Address - Phone:304-927-1495
Mailing Address - Fax:304-927-5813
Practice Address - Street 1:146 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1826
Practice Address - Country:US
Practice Address - Phone:304-927-1495
Practice Address - Fax:304-927-5813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROANE COUNTY FAMILY HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035046000Medicaid
5118241Medicare ID - Type Unspecified
511824Medicare Oscar/Certification