Provider Demographics
NPI:1952402463
Name:PUTNAM COUNTY HEALTH DEPT
Entity type:Organization
Organization Name:PUTNAM COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-757-2541
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-0892
Mailing Address - Country:US
Mailing Address - Phone:304-757-2541
Mailing Address - Fax:304-757-7287
Practice Address - Street 1:11878 WINFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-7914
Practice Address - Country:US
Practice Address - Phone:304-757-2541
Practice Address - Fax:304-757-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-06-10
Deactivation Date:2014-12-16
Deactivation Code:
Reactivation Date:2019-08-29
Provider Licenses
StateLicense IDTaxonomies
WV042197251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004739Medicaid
WVFV92461Medicare PIN