Healthcare Provider Details

I. General information

NPI: 1780853440
Provider Name (Legal Business Name): WIRT COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MULBERRY ST
ELIZABETH WV
26143-0189
US

IV. Provider business mailing address

2507 9TH AVE
PARKERSBURG WV
26101-5855
US

V. Phone/Fax

Practice location:
  • Phone: 304-275-4279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateWV

VIII. Authorized Official

Name: LINDSEY FETTY
Title or Position: MEDICAID SPECIALIST
Credential:
Phone: 304-485-6513