MEDICARE: E. A. HAWSE HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700014180	OTHER	WV	PVFM MOOREFIELD OFFICE NPI

General Provider Information

NPI Number	:	1417437591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E. A. HAWSE HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:
City	:	BAKER
State	:	WV
Zip	:	26801-0097
Country	:	US
Telephone Number	:	304-897-5915
Fax Number	:	304-897-6216

Provider Business Practice Location Address
First Line	:	345 CALEDONIA HEIGHTS RD
Second Line	:
City	:	MOOREFIELD
State	:	WV
Zip	:	26836-8455
Country	:	US
Telephone Number	:	304-530-3450
Fax Number	:	304-897-6216

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	BRENDA LEIGH THOMPSON
Credential	:
Telephone Number	:	304-897-5915

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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