Healthcare Provider Details

I. General information

NPI: 1225096027
Provider Name (Legal Business Name): E.A. HAWSE HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HAROLD K MICHAELS DR
MATHIAS WV
26812-8142
US

IV. Provider business mailing address

PO BOX 97
BAKER WV
26801-0097
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-5915
  • Fax: 304-897-6216
Mailing address:
  • Phone: 304-897-5915
  • Fax: 304-897-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA WALLS
Title or Position: CEO
Credential:
Phone: 304-897-5915