1376572479 NPI number — FAMILY HEALTHCARE ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376572479 NPI number — FAMILY HEALTHCARE ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTHCARE ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376572479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1650
Provider Second Line Business Mailing Address:
MAIN STREET FAMILY HEALTHCARE ASSOCIATES
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24874-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-732-6735
Provider Business Mailing Address Fax Number:
304-732-9218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6TH AVENUE & VINUS STREET
Provider Second Line Business Practice Location Address:
FAMILY HEALTHCARE ASSOCIATES INC
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-664-5699
Provider Business Practice Location Address Fax Number:
304-664-5031
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUSCARI
Authorized Official First Name:
SAMUE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-294-4880

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 25 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5301010002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: FA9306625 . This is a "STATE MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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