Healthcare Provider Details

I. General information

NPI: 1700815800
Provider Name (Legal Business Name): FAMILY HEALTHCARE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HOWARD AVENUE
MULLENS WV
25882-0205
US

IV. Provider business mailing address

PO BOX 1650 97 MAIN AVE
PINEVILLE WV
24874-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-294-4880
  • Fax: 304-294-6480
Mailing address:
  • Phone: 304-732-6735
  • Fax: 304-732-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2010-000,413
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMUEL A MUSCARI SR.
Title or Position: PRESIDENT
Credential: DO
Phone: 304-294-4880