Healthcare Provider Details

I. General information

NPI: 1699728337
Provider Name (Legal Business Name): WETZEL COUNTY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EAST BENJAMIN DRIVE
NEW MARTINSVILLE WV
26155-2705
US

IV. Provider business mailing address

PO BOX 244
NEW MARTINSVILLE WV
26155-0244
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-8000
  • Fax: 304-455-8075
Mailing address:
  • Phone: 304-455-8006
  • Fax: 304-455-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWIN SZEWCZYK
Title or Position: CFO
Credential:
Phone: 304-455-8013