Provider Demographics
NPI:1538248133
Name:ROANE COUNTY FAMILY HEALTH CARE, INC.
Entity type:Organization
Organization Name:ROANE COUNTY FAMILY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-927-8143
Mailing Address - Street 1:146 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1826
Mailing Address - Country:US
Mailing Address - Phone:304-927-1495
Mailing Address - Fax:304-927-8198
Practice Address - Street 1:146 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1826
Practice Address - Country:US
Practice Address - Phone:304-927-1495
Practice Address - Fax:304-927-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0022984000Medicaid