Healthcare Provider Details

I. General information

NPI: 1659772598
Provider Name (Legal Business Name): WILLIAM R SHARPE JR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 SHARPE HOSPITAL RD
WESTON WV
26452-8550
US

IV. Provider business mailing address

936 SHARPE HOSPITAL RD
WESTON WV
26452-8550
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-1210
  • Fax: 304-269-6235
Mailing address:
  • Phone: 304-269-1210
  • Fax: 304-269-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number10479769
License Number StateWV

VIII. Authorized Official

Name: MR. D PARKER HADDIX
Title or Position: CEO
Credential: MBA
Phone: 304-269-1210