1659431344 NPI number — WETZEL COUNTY HOSPITAL

Table of content: (NPI 1659431344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659431344 NPI number — WETZEL COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WETZEL COUNTY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WETZEL COUNTY HOSPITAL HOME INFUSION SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659431344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 N STATE ROUTE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW MARTINSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26155-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-455-5515
Provider Business Mailing Address Fax Number:
304-455-4796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 N STATE ROUTE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW MARTINSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26155-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-455-5515
Provider Business Practice Location Address Fax Number:
304-455-4796
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTNEY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
CFO ASSISTANT ADMINISTRATOR
Authorized Official Telephone Number:
304-455-8013

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  OP0551187 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336H0001X , with the licence number: OP0551187 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 732601 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: INF06A . This is a "HEALTH PLAN UPPER OH VALL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0913597 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001221004 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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