Provider Demographics
NPI:1932662905
Name:ELKVIEW HEALTH
Entity Type:Organization
Organization Name:ELKVIEW HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:304-935-2026
Mailing Address - Street 1:PO BOX 3391
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25333-3391
Mailing Address - Country:US
Mailing Address - Phone:304-935-2026
Mailing Address - Fax:304-935-2073
Practice Address - Street 1:105 CREDES LNDG
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071-8185
Practice Address - Country:US
Practice Address - Phone:304-935-2026
Practice Address - Fax:304-935-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012013Medicaid