Provider Demographics
NPI:1588749188
Name:STATE OF WEST VIRGINIA WELCH COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:STATE OF WEST VIRGINIA WELCH COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-436-8680
Mailing Address - Street 1:454 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2029
Mailing Address - Country:US
Mailing Address - Phone:304-436-8680
Mailing Address - Fax:304-436-6380
Practice Address - Street 1:454 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2029
Practice Address - Country:US
Practice Address - Phone:304-436-8680
Practice Address - Fax:304-436-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVEXEMPT261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001848003Medicaid
WV0001848003Medicaid