Provider Demographics
NPI:1205030525
Name:WEIRTON MEDICAL CENTER INC
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER INC
Other - Org Name:CARL JONES, DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-723-3093
Mailing Address - Street 1:PO BOX 2411
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1611
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 511
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-723-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEIRTON MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-12
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1707207RG0100X
WV21706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9298808Medicaid
OH2124338Medicaid
WV0001352005Medicaid
WV6000020000Medicaid
WV6000020000Medicaid
WV0872143Medicare PIN
OH9350173Medicare PIN
G17358Medicare UPIN
WV9350183Medicare PIN
OH9298808Medicaid
WV0872144Medicare PIN
OH9350174Medicare PIN