Provider Demographics
NPI:1699728337
Name:WETZEL COUNTY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:WETZEL COUNTY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-8013
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-0244
Mailing Address - Country:US
Mailing Address - Phone:304-455-8006
Mailing Address - Fax:304-455-8075
Practice Address - Street 1:3 EAST BENJAMIN DRIVE
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2705
Practice Address - Country:US
Practice Address - Phone:304-455-8000
Practice Address - Fax:304-455-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV38710005425Medicaid
WV3810005420Medicaid
WV3810005423Medicaid
OH0954721Medicaid
WV0001221001Medicaid
WV3810005421Medicaid
WV3810005424Medicaid
WV3810005426Medicaid
WV9327191Medicare ID - Type UnspecifiedMEDICARE PART B
WV3810005421Medicaid