Provider Demographics
NPI:1093883324
Name:RAINELLE MEDICAL CENTER INC
Entity type:Organization
Organization Name:RAINELLE MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-438-6188
Mailing Address - Street 1:1502 MEADOW BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-9655
Mailing Address - Country:US
Mailing Address - Phone:304-484-7755
Mailing Address - Fax:304-484-6205
Practice Address - Street 1:8971 SEWELL CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MEADOW BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25976
Practice Address - Country:US
Practice Address - Phone:304-484-7755
Practice Address - Fax:304-484-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035241003Medicaid
WV511883Medicare ID - Type UnspecifiedMEDICARE-FQHC
WV5118141Medicare ID - Type UnspecifiedMEDICARE PALMETTO