Healthcare Provider Details

I. General information

NPI: 1932868577
Provider Name (Legal Business Name): E. A. HAWSE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAIN ST
ROMNEY WV
26757-1828
US

IV. Provider business mailing address

17978 STATE ROAD 55
BAKER WV
26801-8626
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-5915
  • Fax: 304-897-6216
Mailing address:
  • Phone: 304-897-5915
  • Fax:

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: CHRISTOPHER HAHN
Title or Position: OPERATIONS
Credential:
Phone: 304-822-3838