Provider Demographics
NPI:1619921947
Name:WEIRTON MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER, INC
Other - Org Name:WEIRTON MEDIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-797-6452
Mailing Address - Street 1:601 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5014
Mailing Address - Country:US
Mailing Address - Phone:304-797-6000
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV120282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0808OtherBLUE CROSS
WV0001352000Medicaid
OH9298808Medicaid
WV000313240OtherMOUNTAIN STATE BC/BS
PA100774168Medicaid
PA100774168Medicaid
WV510023Medicare Oscar/Certification