Provider Demographics
NPI:1659772598
Name:WILLIAM R SHARPE JR HOSPITAL
Entity Type:Organization
Organization Name:WILLIAM R SHARPE JR HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:HADDIX
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-269-1210
Mailing Address - Street 1:936 SHARPE HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8550
Mailing Address - Country:US
Mailing Address - Phone:304-269-1210
Mailing Address - Fax:304-269-6235
Practice Address - Street 1:936 SHARPE HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8550
Practice Address - Country:US
Practice Address - Phone:304-269-1210
Practice Address - Fax:304-269-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10479769103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV514010Medicare Oscar/Certification