Provider Demographics
NPI:1720104219
Name:RITCHIE COUNTY PRIMARY CARE ASSOC INC
Entity Type:Organization
Organization Name:RITCHIE COUNTY PRIMARY CARE ASSOC INC
Other - Org Name:ST. MARY'S HIGH SCHOOL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-643-4005
Mailing Address - Street 1:L-4162
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:304-643-4005
Mailing Address - Fax:304-643-4007
Practice Address - Street 1:2330 N PLEASANTS HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-5008
Practice Address - Country:US
Practice Address - Phone:855-552-8907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008817Medicaid
511921Medicare Oscar/Certification