Healthcare Provider Details

I. General information

NPI: 1033299862
Provider Name (Legal Business Name): MOUNTAINEER COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 WINCHESTER ST
PAW PAW WV
25434-0002
US

IV. Provider business mailing address

PO BOX 2 783 WINCHESTER ST
PAW PAW WV
25434-0002
US

V. Phone/Fax

Practice location:
  • Phone: 304-947-5500
  • Fax: 304-947-5563
Mailing address:
  • Phone: 304-947-5500
  • Fax: 304-947-5563

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: MS. REBECCA THOMAS
Title or Position: CEO
Credential:
Phone: 304-947-5500