Provider Demographics
NPI:1831246362
Name:NEW RIVER HEALTH ASSOCIATION INC
Entity type:Organization
Organization Name:NEW RIVER HEALTH ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-469-2905
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-465-1378
Mailing Address - Fax:304-469-2981
Practice Address - Street 1:601 JONES AVENUE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2099
Practice Address - Country:US
Practice Address - Phone:304-469-4875
Practice Address - Fax:304-469-8036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW RIVER HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV819778261Q00000X
WV1036-9138261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035165000Medicaid
WV511964Medicare PIN
WV5119641Medicare PIN