Provider Demographics
NPI:1083904403
Name:WEIRTON MEDICAL CENTER INC
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER INC
Other - Org Name:WEIRTON MEDICAL CENTER ANESTHESIA DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-797-6000
Mailing Address - Street 1:109 MT WOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5014
Mailing Address - Country:US
Mailing Address - Phone:304-233-2455
Mailing Address - Fax:304-233-6073
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty