Healthcare Provider Details

I. General information

NPI: 1023148673
Provider Name (Legal Business Name): BROOKE CNTY HLTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 MAIN ST
WELLSBURG WV
26070-1743
US

IV. Provider business mailing address

632 MAIN ST
WELLSBURG WV
26070-1743
US

V. Phone/Fax

Practice location:
  • Phone: 304-737-3665
  • Fax: 304-737-3689
Mailing address:
  • Phone: 304-737-3665
  • Fax: 304-737-3689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number17078
License Number StateWV

VIII. Authorized Official

Name: JOSEPH DEPETRO
Title or Position: HEALTH OFFICER
Credential: M.D.
Phone: 304-737-3665