Provider Demographics
NPI:1518155399
Name:COUNTY OF MORGAN
Entity Type:Organization
Organization Name:COUNTY OF MORGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-267-3595
Mailing Address - Street 1:109 S. COLLEGE ST.
Mailing Address - Street 2:RESA VIII
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25414
Mailing Address - Country:US
Mailing Address - Phone:304-267-6359
Mailing Address - Fax:304-267-3599
Practice Address - Street 1:247 HARRISON AVE.
Practice Address - Street 2:COUNTY OF MORGAN
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1221
Practice Address - Country:US
Practice Address - Phone:304-258-2014
Practice Address - Fax:304-267-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0012181000OtherPROVIDER NUMBER