Healthcare Provider Details

I. General information

NPI: 1215092473
Provider Name (Legal Business Name): CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 MASON DIXON HWY
BLACKSVILLE WV
26521
US

IV. Provider business mailing address

PO BOX 72
BLACKSVILLE WV
26521-0072
US

V. Phone/Fax

Practice location:
  • Phone: 304-432-8211
  • Fax: 304-432-8213
Mailing address:
  • Phone: 304-432-8211
  • Fax: 304-432-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number51D0236727
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: REBECCA J THOMAS
Title or Position: CEO
Credential:
Phone: 304-432-8211