Provider Demographics
NPI:1154476513
Name:STATE OF WEST VIRGINIA WELCH EMERGENCY HOSPITAL
Entity Type:Organization
Organization Name:STATE OF WEST VIRGINIA WELCH EMERGENCY HOSPITAL
Other - Org Name:WELCH COMMUNITY HOSPITAL-MDGRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-436-8680
Mailing Address - Street 1:454 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2029
Mailing Address - Country:US
Mailing Address - Phone:304-436-8708
Mailing Address - Fax:304-436-8716
Practice Address - Street 1:454 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2029
Practice Address - Country:US
Practice Address - Phone:304-436-8708
Practice Address - Fax:304-436-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722927OtherDR. TUMBOKON-BCBS
WV0094796000Medicaid
WV0093834000Medicaid
WV000025528OtherDR. SULTAN-BCBS
WV0094692000Medicaid
WV0094692000Medicaid
WV1619057536Medicare UPIN
WV0093834000Medicaid
WVD49459Medicare UPIN
WV0094796000Medicaid
WVSU7110971Medicare ID - Type UnspecifiedDR. SULTAN-MEDICARE