Provider Demographics
NPI:1659575538
Name:WEIRTON MEDICAL CENTER INC
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER INC
Other - Org Name:ROGER ISLA, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-797-6196
Mailing Address - Street 1:PO BOX 2411
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1611
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:
Practice Address - Street 1:4317 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3619
Practice Address - Country:US
Practice Address - Phone:304-723-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEIRTON MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-13
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X, 208600000X
WV10220207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00013520005Medicaid
OH9298808Medicaid
D49194Medicare UPIN
WV00013520005Medicaid
WV9350185Medicare PIN