Provider Demographics
NPI:1265505143
Name:CABELL-HUNTINGTON HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CABELL-HUNTINGTON HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAZELETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-523-6483
Mailing Address - Street 1:703 SEVENTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2115
Mailing Address - Country:US
Mailing Address - Phone:304-523-6483
Mailing Address - Fax:304-523-6482
Practice Address - Street 1:703 SEVENTH AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2115
Practice Address - Country:US
Practice Address - Phone:304-523-6483
Practice Address - Fax:304-523-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2083P0901X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021437000Medicaid
WV0022191000Medicaid
WVCAFV93561Medicare ID - Type Unspecified