Healthcare Provider Details

I. General information

NPI: 1205030525
Provider Name (Legal Business Name): WEIRTON MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY SUITE 511
WEIRTON WV
26062-5053
US

IV. Provider business mailing address

PO BOX 2411
WEIRTON WV
26062-1611
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3093
  • Fax:
Mailing address:
  • Phone: 304-723-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1707
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21706
License Number StateWV

VIII. Authorized Official

Name: CARL JONES
Title or Position: STAFF
Credential: DO
Phone: 304-723-3093