Healthcare Provider Details

I. General information

NPI: 1659544013
Provider Name (Legal Business Name): WOMEN'S HEALTH CENTER OF WV, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WASHINGTON STREET WOMEN'S HEALTH CENTER OF WEST VIRGINIA INC. - RIGHT FRO
CHARLESTON WV
25302
US

IV. Provider business mailing address

P.O. BOX 20580
CHARLESTON WV
25362
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-9434
  • Fax: 304-344-1756
Mailing address:
  • Phone: 304-344-9841
  • Fax: 304-344-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberAP00941332
License Number StateWV

VIII. Authorized Official

Name: MS. VANIA LEE RIDDLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-344-9841