Provider Demographics
NPI:1972302388
Name:MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Entity type:Organization
Organization Name:MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP LEGAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WESTBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-374-1581
Mailing Address - Street 1:314 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:424 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-1249
Practice Address - Country:US
Practice Address - Phone:740-568-4190
Practice Address - Fax:740-568-4195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-10
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health