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General NPI Number Information
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NPI Number | 1548777527
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Entity Type | Organization
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Legal Business Name | WIRT COUNTY HEALTH SERVICES ASSOCIATION INC
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 3705 EMERSON AVE
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City | PARKERSBURG
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State | WV
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Zip | 26104-1118
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Country | US
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Telephone | 304-917-3733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 609
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City | ELIZABETH
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State | WV
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Zip | 26143-0609
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Country | US
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Telephone | 304-275-3301
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Fax | 304-275-4798
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | VICKI LYNN KNICELY
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Credential |
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Telephone | 304-275-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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