Provider Demographics
NPI:1922026988
Name:BECKLEY-RALEIGH COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:BECKLEY-RALEIGH COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-255-6564
Mailing Address - Street 1:1602 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3310
Mailing Address - Country:US
Mailing Address - Phone:304-255-6564
Mailing Address - Fax:304-252-0466
Practice Address - Street 1:1602 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3310
Practice Address - Country:US
Practice Address - Phone:304-252-8531
Practice Address - Fax:304-252-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021384000Medicaid
WV9263681Medicare ID - Type Unspecified