Healthcare Provider Details

I. General information

NPI: 1265101273
Provider Name (Legal Business Name): RAINELLE MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 SPARTAN LN
LEWISBURG WV
24901-9438
US

IV. Provider business mailing address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-1052
  • Fax: 304-645-1055
Mailing address:
  • Phone: 304-438-6188
  • Fax: 304-438-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DEBRA J DAVIDSON-BENNETT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 304-438-6188