Provider Demographics
NPI:1659456119
Name:WHEELING HOSPITAL
Entity Type:Organization
Organization Name:WHEELING HOSPITAL
Other - Org Name:MEDICAL PARK HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-243-3681
Mailing Address - Street 1:1 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6379
Mailing Address - Country:US
Mailing Address - Phone:304-243-8507
Mailing Address - Fax:304-243-6346
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6379
Practice Address - Country:US
Practice Address - Phone:304-243-8507
Practice Address - Fax:304-243-6346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHEELING HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0551188332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001131011Medicaid
OH0884600Medicaid
WV001705300OtherMOUNTAIN STATE BCBS
OH0884600Medicaid