Healthcare Provider Details

I. General information

NPI: 1073603551
Provider Name (Legal Business Name): PENDLETON COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MILL ROAD
FRANKLIN WV
26807-0520
US

IV. Provider business mailing address

223 MILL ROAD PO BOX 520
FRANKLIN WV
26807-0520
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-7565
  • Fax: 304-358-2471
Mailing address:
  • Phone: 304-358-7565
  • Fax: 304-358-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number001
License Number StateWV

VIII. Authorized Official

Name: MRS. CARMEN R REXRODE
Title or Position: PHYSICIAN DIRECTOR
Credential: M. D.
Phone: 304-358-7565