Healthcare Provider Details

I. General information

NPI: 1255518908
Provider Name (Legal Business Name): WEIRTON MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY SUITE 506
WEIRTON WV
26062-5053
US

IV. Provider business mailing address

PO BOX 2147
WEIRTON WV
26062-1347
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6520
  • Fax:
Mailing address:
  • Phone: 304-723-6040
  • Fax: 304-723-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1857
License Number StateWV

VIII. Authorized Official

Name: LISA NOBLE
Title or Position: PHYSICIAN
Credential: DO
Phone: 304-797-6520