Healthcare Provider Details

I. General information

NPI: 1326186586
Provider Name (Legal Business Name): WETZEL COUNTY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12960 SHORTLINE HWY
PINE GROVE WV
26419
US

IV. Provider business mailing address

P.O. BOX 244
NEW MARTINSVILLE WV
26155-2705
US

V. Phone/Fax

Practice location:
  • Phone: 304-889-3344
  • Fax: 304-889-3366
Mailing address:
  • Phone: 304-455-8000
  • Fax: 304-455-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateWV

VIII. Authorized Official

Name: BRIAN FELICI
Title or Position: CEO
Credential:
Phone: 304-455-8000