Provider Demographics
NPI:1750489415
Name:HAMPSHIRE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:HAMPSHIRE COUNTY BOARD OF HEALTH
Other - Org Name:HAMPSHIRE COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-822-3585
Mailing Address - Street 1:HC 71 BOX 9
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704-9502
Mailing Address - Country:US
Mailing Address - Phone:304-496-9641
Mailing Address - Fax:304-496-9650
Practice Address - Street 1:HC 71 BOX 9
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26704-9502
Practice Address - Country:US
Practice Address - Phone:304-496-9641
Practice Address - Fax:304-496-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVN/A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005564Medicaid
WV3810005564Medicaid