Provider Demographics
NPI:1942699608
Name:RURAL HEALTH ACCESS
Entity Type:Organization
Organization Name:RURAL HEALTH ACCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-855-1200
Mailing Address - Street 1:386 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-9202
Mailing Address - Country:US
Mailing Address - Phone:304-855-1200
Mailing Address - Fax:304-855-1230
Practice Address - Street 1:386 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9202
Practice Address - Country:US
Practice Address - Phone:304-855-1200
Practice Address - Fax:304-855-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22652261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB02030991OtherMEDICARE
WV3810012177Medicaid