Provider Demographics
NPI:1710165568
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:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:M RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-367-8740
Mailing Address - Street 1:1322 LOCUST AVE
Mailing Address - Street 2:PO BOX 1122
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1436
Mailing Address - Country:US
Mailing Address - Phone:304-367-8710
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:1 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1016
Practice Address - Country:US
Practice Address - Phone:304-592-1040
Practice Address - Fax:304-592-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI511925Medicare Oscar/Certification