Provider Demographics
NPI:1518003011
Name:MONONGALIA COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:MONONGALIA COUNTY BOARD OF HEALTH
Other - Org Name:MONONGALIA COUNTY HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:STROSNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-598-5140
Mailing Address - Street 1:453 VANVOORHIS ROAD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-598-5100
Mailing Address - Fax:304-598-5199
Practice Address - Street 1:453 VANVOORHIS ROAD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-598-5100
Practice Address - Fax:304-598-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV2386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021420006Medicaid