Provider Demographics
NPI:1194829374
Name:CITY OF SISTERSVILLE
Entity Type:Organization
Organization Name:CITY OF SISTERSVILLE
Other - Org Name:SWING BED UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHADOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-652-2611
Mailing Address - Street 1:SISTERSVILLE GENERAL HOSPITAL
Mailing Address - Street 2:314 S WELLS ST
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1098
Mailing Address - Country:US
Mailing Address - Phone:304-652-2611
Mailing Address - Fax:304-652-1448
Practice Address - Street 1:314 S WELLS ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1098
Practice Address - Country:US
Practice Address - Phone:304-652-2611
Practice Address - Fax:304-652-1448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERSVILLE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002178000Medicaid
WV0002178000Medicaid