Healthcare Provider Details

I. General information

NPI: 1538592043
Provider Name (Legal Business Name): MONONGALIA COUNTY GENERAL HOSPITAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 DEEP CREEK DR STE 200
MC HENRY MD
21541-1713
US

IV. Provider business mailing address

PO BOX 1615
MORGANTOWN WV
26507-1615
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-5006
  • Fax: 304-636-4898
Mailing address:
  • Phone: 304-598-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number35
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLYDE R SCHERICH
Title or Position: VP OF FINANCE
Credential:
Phone: 304-598-1204