Provider Demographics
NPI:1871606517
Name:COMMUNITY HEALTH ASSOCIATION
Entity type:Organization
Organization Name:COMMUNITY HEALTH ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-373-1475
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0588
Mailing Address - Country:US
Mailing Address - Phone:304-373-1578
Mailing Address - Fax:304-372-2749
Practice Address - Street 1:122 PINNELL STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271
Practice Address - Country:US
Practice Address - Phone:304-373-1578
Practice Address - Fax:304-372-2749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001320007Medicaid
WV9328803OtherGROUP PTAN
WV9328803OtherGROUP PTAN