Provider Demographics
NPI:1073609525
Name:DODDRIDGE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:DODDRIDGE COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-873-1531
Mailing Address - Street 1:RR 2 BOX 54
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:WV
Mailing Address - Zip Code:26456-9512
Mailing Address - Country:US
Mailing Address - Phone:304-873-1531
Mailing Address - Fax:304-873-2994
Practice Address - Street 1:RR 2 BOX 54
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-9512
Practice Address - Country:US
Practice Address - Phone:304-873-1531
Practice Address - Fax:304-873-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV008845251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021476001Medicaid