Provider Demographics
NPI:1285895433
Name:RICHWOOD FAMILY PRACTICE
Entity type:Organization
Organization Name:RICHWOOD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-872-2891
Mailing Address - Street 1:74 AVE B
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-0000
Mailing Address - Country:US
Mailing Address - Phone:304-872-8434
Mailing Address - Fax:304-872-8417
Practice Address - Street 1:74 AVE B
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-0000
Practice Address - Country:US
Practice Address - Phone:304-872-8434
Practice Address - Fax:304-872-8417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERSVILLE OUTPATIENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty