Provider Demographics
NPI:1568616605
Name:CITY OF SISTERSVILLE
Entity Type:Organization
Organization Name:CITY OF SISTERSVILLE
Other - Org Name:SISTERSVILLE GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LOWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-447-2501
Mailing Address - Street 1:314 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1098
Mailing Address - Country:US
Mailing Address - Phone:304-652-2611
Mailing Address - Fax:304-652-1448
Practice Address - Street 1:314 S WELLS ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1098
Practice Address - Country:US
Practice Address - Phone:304-652-2611
Practice Address - Fax:304-652-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV117261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002178002Medicaid
WV511304Medicare Oscar/Certification