Healthcare Provider Details

I. General information

NPI: 1669074175
Provider Name (Legal Business Name): E. A. HAWSE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 12/29/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E. MAIN STREET
WARDENSVILLE WV
26851
US

IV. Provider business mailing address

PO BOX 97
BAKER WV
26801-0097
US

V. Phone/Fax

Practice location:
  • Phone: 304-874-4012
  • Fax:
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: MEREDITH MICHELLE HEISHMAN
Title or Position: CREDENTIALING
Credential:
Phone: 304-897-5915