Healthcare Provider Details

I. General information

NPI: 1508465162
Provider Name (Legal Business Name): MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIR ST
MIDDLEBOURNE WV
26149-9525
US

IV. Provider business mailing address

C/O PAUL WESTBROCK 314 S WELLS ST
SISTERSVILLE WV
26175
US

V. Phone/Fax

Practice location:
  • Phone: 304-758-5000
  • Fax: 304-758-5022
Mailing address:
  • Phone: 304-652-2611
  • Fax: 304-652-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL WESTBROCK
Title or Position: VP, LEGAL AFFAIRS
Credential:
Phone: 740-374-1581