Provider Demographics
NPI:1952448904
Name:PROCTORVILLE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:PROCTORVILLE HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:740-886-2674
Mailing Address - Street 1:501 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-3015
Mailing Address - Country:US
Mailing Address - Phone:740-886-2676
Mailing Address - Fax:
Practice Address - Street 1:501 STATE ST
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-3015
Practice Address - Country:US
Practice Address - Phone:740-886-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care