Provider Demographics
NPI:1962506212
Name:WEIRTON MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER, INC
Other - Org Name:WEIRTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:ENDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-797-6136
Mailing Address - Street 1:601 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5014
Mailing Address - Country:US
Mailing Address - Phone:304-797-6000
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000324432OtherMOUNTAIN STATE BC/BS SNF
WV001352003Medicaid
510023OtherCOVENTRY PRODUCTS
OH9298808Medicaid
PA100774168Medicaid
WV000324432OtherMOUNTAIN STATE BC/BS SNF
PA100774168Medicaid