Provider Demographics
NPI:1902835010
Name:FAMILY HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUSCARI
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:304-294-4880
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:97 MAIN AVE
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-1650
Mailing Address - Country:US
Mailing Address - Phone:304-732-6735
Mailing Address - Fax:304-732-9218
Practice Address - Street 1:114 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-0114
Practice Address - Country:US
Practice Address - Phone:304-583-0019
Practice Address - Fax:304-583-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
WV0015261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5301010000Medicaid
FA9306624OtherSTATE MEDICARE
FA9306624OtherSTATE MEDICARE