Provider Demographics
NPI:1255955787
Name:MIRT, COREY (BS/CM)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:MIRT
Suffix:
Gender:M
Credentials:BS/CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 19TH STREET P.O. BOX 6400
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2525
Mailing Address - Country:US
Mailing Address - Phone:412-605-4443
Mailing Address - Fax:
Practice Address - Street 1:111 19TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3709
Practice Address - Country:US
Practice Address - Phone:304-234-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator