Healthcare Provider Details

I. General information

NPI: 1285895433
Provider Name (Legal Business Name): RICHWOOD FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 AVE B
RICHWOOD WV
26261-0000
US

IV. Provider business mailing address

74 AVE B
RICHWOOD WV
26261-0000
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-8434
  • Fax: 304-872-8417
Mailing address:
  • Phone: 304-872-8434
  • Fax: 304-872-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH A HILL
Title or Position: CEO
Credential: RN
Phone: 304-872-2891