Provider Demographics
NPI:1437775251
Name:E. A. HAWSE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:E. A. HAWSE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-897-5915
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:WV
Mailing Address - Zip Code:26801-0097
Mailing Address - Country:US
Mailing Address - Phone:304-897-5915
Mailing Address - Fax:
Practice Address - Street 1:HAMPSHIRE HIGH SCHOOL
Practice Address - Street 2:157 TROJAN WAY
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6317
Practice Address - Country:US
Practice Address - Phone:304-897-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty