Healthcare Provider Details

I. General information

NPI: 1760733984
Provider Name (Legal Business Name): WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 CAMDEN AVE
PARKERSBURG WV
26101-5652
US

IV. Provider business mailing address

2610 CAMDEN AVE
PARKERSBURG WV
26101-5652
US

V. Phone/Fax

Practice location:
  • Phone: 304-917-3733
  • Fax: 304-917-3750
Mailing address:
  • Phone: 304-917-3733
  • Fax: 304-917-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. VICKI L KNICELY
Title or Position: BILLING/CREDENTIALING SUPERVISOR
Credential:
Phone: 304-275-3301