1114468113 NPI number — WHEELING HOSPITAL INC

Table of content: BEVERLY DAWN EMBRY CRNA (NPI 1659379402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114468113 NPI number — WHEELING HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHEELING HOSPITAL INC
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:
Provider Other Organization Name Type Code:
6
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:
1114468113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 MEDICAL PARK
Provider Second Line Business Mailing Address:
SUITE 504
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-6392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-242-0588
Provider Business Mailing Address Fax Number:
304-242-7267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-242-0588
Provider Business Practice Location Address Fax Number:
304-242-7267
Provider Enumeration Date:
03/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VIOLI
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
304-243-3263

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  89 , 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)

  • Identifier: 0001131002 . This is a "MEDICAID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0001131000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com