Provider Demographics
NPI:1700952199
Name:WETZEL COUNTY HOSPTIAL
Entity Type:Organization
Organization Name:WETZEL COUNTY HOSPTIAL
Other - Org Name:WETZEL COUNTY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:304-455-8013
Mailing Address - Street 1:299 N STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2243
Mailing Address - Country:US
Mailing Address - Phone:304-455-5515
Mailing Address - Fax:304-455-4796
Practice Address - Street 1:299 N STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2243
Practice Address - Country:US
Practice Address - Phone:304-455-5515
Practice Address - Fax:304-455-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV95332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001221005Medicaid
OH0892315Medicaid
DME06OtherHEALTH PLAN UPPER OH VALL
OH0892315Medicaid