Provider Demographics
NPI:1073603551
Name:PENDLETON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:PENDLETON COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REXRODE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:304-358-7565
Mailing Address - Street 1:223 MILL ROAD
Mailing Address - Street 2:PO BOX 520
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0520
Mailing Address - Country:US
Mailing Address - Phone:304-358-7565
Mailing Address - Fax:304-358-2471
Practice Address - Street 1:223 MILL ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-0520
Practice Address - Country:US
Practice Address - Phone:304-358-7565
Practice Address - Fax:304-358-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0017909454OtherBLUE CROSS BLUE SHIELD
WV=========OtherACORDIA NATIONAL/WELL FAR
WVFV90331Medicare PIN