Provider Demographics
NPI:1033327564
Name:THE MAYBEURY CLINIC
Entity Type:Organization
Organization Name:THE MAYBEURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-827-4800
Mailing Address - Street 1:RT 52
Mailing Address - Street 2:HOUSE 15
Mailing Address - City:MAYBEURY
Mailing Address - State:WV
Mailing Address - Zip Code:24861-0169
Mailing Address - Country:US
Mailing Address - Phone:304-827-4800
Mailing Address - Fax:304-827-4801
Practice Address - Street 1:RT. 52
Practice Address - Street 2:HOUSE 15
Practice Address - City:MAYBEURY
Practice Address - State:WV
Practice Address - Zip Code:24861-0169
Practice Address - Country:US
Practice Address - Phone:304-827-4800
Practice Address - Fax:304-827-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034650000Medicaid
WV513871Medicare ID - Type Unspecified