Healthcare Provider Details

I. General information

NPI: 1548777527
Provider Name (Legal Business Name): WIRT COUNTY HEALTH SERVICES ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 EMERSON AVE
PARKERSBURG WV
26104-1118
US

IV. Provider business mailing address

PO BOX 609
ELIZABETH WV
26143-0609
US

V. Phone/Fax

Practice location:
  • Phone: 304-917-3733
  • Fax:
Mailing address:
  • Phone: 304-275-3301
  • Fax: 304-275-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: VICKI LYNN KNICELY
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 304-275-3301