Healthcare Provider Details

I. General information

NPI: 1144423864
Provider Name (Legal Business Name): WEIRTON MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COLLIERS WAY
WEIRTON WV
26062-5014
US

IV. Provider business mailing address

PO BOX 2768
WEIRTON WV
26062-1968
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6313
  • Fax:
Mailing address:
  • Phone: 304-723-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA PERRY
Title or Position: ADMINISTRATION
Credential:
Phone: 304-797-6359