=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437397486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASON COUNTY HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2009
-----------------------------------------------------
Last Update Date | 01/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 5TH ST
-----------------------------------------------------
City | POINT PLEASANT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25550-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-675-3050
-----------------------------------------------------
Fax | 304-675-4801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 5TH ST
-----------------------------------------------------
City | POINT PLEASANT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25550-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-675-3050
-----------------------------------------------------
Fax | 304-675-4801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DIANA L. RIDDLE
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 304-675-3050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------