Provider Demographics
NPI:1497822746
Name:MINERAL COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:MINERAL COUNTY BOARD OF HEALTH
Other - Org Name:MINERAL CNTY HLTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-788-1321
Mailing Address - Street 1:541 HARLEY O STAGGERS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-8203
Mailing Address - Country:US
Mailing Address - Phone:304-788-1321
Mailing Address - Fax:304-788-6023
Practice Address - Street 1:HARLEY O. STAGGERS SR. DRIVE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9401
Practice Address - Country:US
Practice Address - Phone:304-788-1321
Practice Address - Fax:304-788-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021252000Medicaid
WV0053885000Medicaid
WV0021252005Medicaid
WV0127589000OtherINDIVIDUAL PROVIDER NO.
WV0021252004Medicaid
WV0021252003Medicaid