1679573026 NPI number — GRAFTON TAYLOR COUNTY BOARD OF HEALTH

Table of content: (NPI 1679573026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679573026 NPI number — GRAFTON TAYLOR COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAFTON TAYLOR COUNTY BOARD OF HEALTH
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:
1679573026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAFTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26354-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-265-1288
Provider Business Mailing Address Fax Number:
304-265-5067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAFTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26354-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-265-1288
Provider Business Practice Location Address Fax Number:
304-265-5067
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
304-265-1288

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  005036 , 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: 0021281002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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