Healthcare Provider Details

I. General information

NPI: 1417037532
Provider Name (Legal Business Name): JEFFERSON COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 WILTSHIRE RD SUITE 1
KEARNEYSVILLE WV
25430-2783
US

IV. Provider business mailing address

1948 WILTSHIRE RD SUITE 1
KEARNEYSVILLE WV
25430-2783
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-8416
  • Fax: 304-728-3319
Mailing address:
  • Phone: 304-728-8416
  • Fax: 304-728-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberA72206
License Number StateWV

VIII. Authorized Official

Name: MR. TERRENCE J REIDY
Title or Position: HEALTH OFFICER
Credential:
Phone: 304-728-8416