Provider Demographics
NPI:1891903050
Name:DAVIS, RUTH D (QRP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:QRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 154
Mailing Address - Street 2:
Mailing Address - City:COTTAGEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25239-9525
Mailing Address - Country:US
Mailing Address - Phone:304-372-6462
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 154
Practice Address - Street 2:
Practice Address - City:COTTAGEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25239-9525
Practice Address - Country:US
Practice Address - Phone:304-372-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVQRP666666171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQRP666666Medicare UPIN