1962506212 NPI number — WEIRTON MEDICAL CENTER, INC

Table of content: (NPI 1962506212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962506212 NPI number — WEIRTON MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEIRTON MEDICAL CENTER, 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:
1962506212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 COLLIERS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEIRTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26062-5014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-797-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 COLLIERS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-5014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-797-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ENDRICH
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-797-6136

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  120 , 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: 100774168 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9298808 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000324432 . This is a "MOUNTAIN STATE BC/BS SNF" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 510023 . This is a "COVENTRY PRODUCTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001352003 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".