Provider Demographics
NPI:1740403443
Name:WETZEL TYLER BOARD OF HEALTH
Entity Type:Organization
Organization Name:WETZEL TYLER BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-337-2001
Mailing Address - Street 1:425 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1200
Mailing Address - Country:US
Mailing Address - Phone:304-337-2001
Mailing Address - Fax:304-337-2004
Practice Address - Street 1:425 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:PADEN CITY
Practice Address - State:WV
Practice Address - Zip Code:26159-1200
Practice Address - Country:US
Practice Address - Phone:304-337-2001
Practice Address - Fax:304-337-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021186000Medicaid
WV0021186004Medicaid
WV0021186001Medicaid