1366762825 NPI number — WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC

Table of content: (NPI 1366762825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366762825 NPI number — WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIRT COUNTY HEALTH SERVICES ASSOCIATION, 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:
1366762825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26143-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-275-3301
Provider Business Mailing Address Fax Number:
304-275-4798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45771-8902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-949-2348
Provider Business Practice Location Address Fax Number:
740-949-2536
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KNICELY
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING/CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
304-275-3301

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0085471 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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