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NPI Code Detail

MEDICARE: E. A. HAWSE HEALTH CENTER, INC.

MEDICARE: E. A. HAWSE HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1639771140
Entity Type Code : Organization
Provider Name (Legal Business Name) : E. A. HAWSE HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : PO BOX 97
Second Line :
City : BAKER
State : WV
Zip : 26801-0097
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 422 S MAIN ST
Second Line :
City : MOOREFIELD
State : WV
Zip : 26836-1238
Country : US
Telephone Number : 304-538-2331
Fax Number :
Authorized Official
Title or Position : CREDENTIALING
Name : MEREDITH MICHELLE HEISHMAN
Credential :
Telephone Number : 304-897-5915
Provider Enumeration Date : 11/10/2020
Last Update Date : 11/24/2020

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