Provider Demographics
NPI:1265606743
Name:BERKELEY -MORGAN COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:BERKELEY -MORGAN COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:304-263-5131
Mailing Address - Street 1:122 WAVERLY CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1214
Mailing Address - Country:US
Mailing Address - Phone:304-263-5131
Mailing Address - Fax:304-263-1067
Practice Address - Street 1:122 WAVERLY CT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-1214
Practice Address - Country:US
Practice Address - Phone:304-263-5131
Practice Address - Fax:304-263-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021267001Medicaid
WV0021267002Medicaid
WV0021267002Medicaid