Provider Demographics
NPI:1659489631
Name:MONONGALIA COUNTY GENERAL HOSPITAL COMPANY
Entity Type:Organization
Organization Name:MONONGALIA COUNTY GENERAL HOSPITAL COMPANY
Other - Org Name:MON HEALTH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-598-1204
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1615
Mailing Address - Country:US
Mailing Address - Phone:304-598-1560
Mailing Address - Fax:304-598-1699
Practice Address - Street 1:1200 JD ANDERSON DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-598-1560
Practice Address - Fax:304-598-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35261Q00000X, 261QA1903X, 282N00000X
WV51D0236653291U00000X
WV3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No291U00000XLaboratoriesClinical Medical Laboratory
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007552420002Medicaid
WV0001360001Medicaid
WV0001360000Medicaid
PA1007552420005Medicaid
WV000301542OtherMT STATE BCBS
PA1007552420002Medicaid