Healthcare Provider Details

I. General information

NPI: 1083478085
Provider Name (Legal Business Name): RITCHIE COUNTY PRIMARY CARE ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 STEPHENSON AVE
PARKERSBURG WV
26101-4889
US

IV. Provider business mailing address

L-4162
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-699-0506
  • Fax:
Mailing address:
  • Phone: 304-643-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WALASHA NEWBROUGH
Title or Position: ACCOUNTING MANAGER,
Credential:
Phone: 304-643-4005