=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710165568
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2008
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 COLUMBIA RD
-----------------------------------------------------
City | SHINNSTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26431-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-592-1040
-----------------------------------------------------
Fax | 304-592-5317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1322 LOCUST AVE PO BOX 1122
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26554-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-367-8710
-----------------------------------------------------
Fax | 304-366-9529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM CEO
-----------------------------------------------------
Name | M RAYMOND ALVAREZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 304-367-8740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------