Provider Demographics
NPI:1598868143
Name:MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Entity type:Organization
Organization Name:MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDERGRIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-366-0700
Mailing Address - Street 1:1322 LOCUST AVE
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1436
Mailing Address - Country:US
Mailing Address - Phone:304-366-0700
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:1 N MARION DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571-9717
Practice Address - Country:US
Practice Address - Phone:304-366-0700
Practice Address - Fax:304-366-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health