| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 410 W Main St, Sophia, West Virginia |
| Authorized Official Name and Position | John R. Schultz (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3044692905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 337 Scarbro WV 25917-0337 Ph: (304) 683-4304 | 410 W Main St Sophia WV 25921 Ph: (304) 683-4304 |
| NPI Number | 1730174988 |
|---|---|
| Provider Enumeration Date | 09/14/2005 |
| Last Update Date | 04/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730174988 | NPI | - | NPPES |
| 0034323000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1036-9138 (West Virginia) | Primary |
New River Health Association, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 Robert C Byrd Dr., Sophia, WV 25921 Phone: 304-469-2905 |