Provider Demographics
NPI:1336113109
Name:DRS RW & JA LOVE MEMORIAL CLINIC
Entity Type:Organization
Organization Name:DRS RW & JA LOVE MEMORIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-530-7755
Mailing Address - Street 1:112 KUYKENDALL LANE
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836
Mailing Address - Country:US
Mailing Address - Phone:304-530-7755
Mailing Address - Fax:304-530-7756
Practice Address - Street 1:112 KUYKENDALL LN
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1167
Practice Address - Country:US
Practice Address - Phone:304-530-7755
Practice Address - Fax:304-530-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034507000Medicaid
WV0034507000Medicaid
WVLO9271681Medicare PIN