Provider Demographics
NPI:1811392442
Name:PENDLETON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:PENDLETON COUNTY BOARD OF HEALTH
Other - Org Name:PENDLETON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REXRODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-358-7565
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:273 MILL ROAD
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0520
Mailing Address - Country:US
Mailing Address - Phone:304-358-7565
Mailing Address - Fax:304-358-2471
Practice Address - Street 1:273 MILL ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-0520
Practice Address - Country:US
Practice Address - Phone:304-358-7565
Practice Address - Fax:304-358-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1035-5878251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ382640001Medicare PIN
WVFV90331Medicare PIN