1790786200 NPI number — BARBOUR COUNTY BOARD OF HEALTH BARBOUR COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1790786200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790786200 NPI number — BARBOUR COUNTY BOARD OF HEALTH BARBOUR COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBOUR COUNTY BOARD OF HEALTH BARBOUR COUNTY HEALTH DEPARTMENT
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:
1790786200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 WABASH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILIPPI
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26416-0019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-457-3315
Provider Business Mailing Address Fax Number:
304-457-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 WABASH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPPI
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26416-0019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-457-3315
Provider Business Practice Location Address Fax Number:
304-457-1296
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KERNS
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
ANNETTE
Authorized Official Title or Position:
DIRECTOR OF HOME HEALTH
Authorized Official Telephone Number:
304-457-3315

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0021197001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000324476 . This is a "MT ST BLUE CR BLUE SHLD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1026259 . This is a "BRICKSTREET MUT. INS CO." identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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