Provider Demographics
NPI:1144408691
Name:MID VALLEY HEALTHCARE INC
Entity Type:Organization
Organization Name:MID VALLEY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-234-3500
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0801
Mailing Address - Country:US
Mailing Address - Phone:304-234-3500
Mailing Address - Fax:304-234-3511
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1215
Practice Address - Country:US
Practice Address - Phone:304-455-3661
Practice Address - Fax:304-234-3511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWOOD HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-07
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV387251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008312Medicaid
WV387OtherSTATE LICENSE
WVPENDINGMedicare PIN