Provider Demographics
NPI:1750326880
Name:WETZEL COUNTY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:WETZEL COUNTY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-8195
Mailing Address - Street 1:3 EAST BENJAMIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2705
Mailing Address - Country:US
Mailing Address - Phone:304-455-8000
Mailing Address - Fax:304-455-4259
Practice Address - Street 1:3 EAST BENJAMIN DRIVE
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2705
Practice Address - Country:US
Practice Address - Phone:304-455-8000
Practice Address - Fax:304-455-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV95282NR1301X
51D0236097291U00000X
WV51D0236097291U00000X
IP05507033336I0012X
WVIP05507033336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No291U00000XLaboratoriesClinical Medical Laboratory
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001221000Medicaid
OH9370345Medicaid
N015OtherHEALTH PLAN OF UPPER OH V
000324362OtherBC/BS PROVIDER #
510072Medicare Oscar/Certification
510072Medicare PIN