Provider Demographics
NPI:1639216039
Name:WETZEL COUNTY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:WETZEL COUNTY HOSPITAL ASSOCIATION
Other - Org Name:MIDDLE ISLAND HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-8013
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-0244
Mailing Address - Country:US
Mailing Address - Phone:304-455-8006
Mailing Address - Fax:304-455-8075
Practice Address - Street 1:100 FAIR AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBOURNE
Practice Address - State:WV
Practice Address - Zip Code:26149-9622
Practice Address - Country:US
Practice Address - Phone:304-758-5100
Practice Address - Fax:304-758-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001221009Medicaid
WV0001221009Medicaid