Provider Demographics
NPI:1851065593
Name:E. A. HAWSE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:E. A. HAWSE HEALTH CENTER, INC.
Other - Org Name:CAPON BRIDGE ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-897-5915
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:WV
Mailing Address - Zip Code:26801-0097
Mailing Address - Country:US
Mailing Address - Phone:304-897-5915
Mailing Address - Fax:
Practice Address - Street 1:99 CAPON SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-9059
Practice Address - Country:US
Practice Address - Phone:304-897-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)