1750785366 NPI number — MONONGALIA COUNTY GENERAL HOSPITAL COMPANY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750785366 NPI number — MONONGALIA COUNTY GENERAL HOSPITAL COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONONGALIA COUNTY GENERAL HOSPITAL COMPANY
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:
MON HEALTH MEDICAL CENTER
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:
1750785366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26507-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-1560
Provider Business Mailing Address Fax Number:
304-598-1699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MANNINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26582-1278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-986-2996
Provider Business Practice Location Address Fax Number:
304-986-2998
Provider Enumeration Date:
10/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHERICH
Authorized Official First Name:
CLYDE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
304-598-1204

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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