MEDICARE: WEBSTER COUNTY BOARD OF EDUCATION

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	251300000X	Local Education Agency (LEA)		WV

General Provider Information

NPI Number	:	1871793950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBSTER COUNTY BOARD OF EDUCATION

Provider Business Mailing Address
First Line	:	404 OLD MAIN DR
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-1360
Country	:	US
Telephone Number	:	304-872-6440
Fax Number	:	304-872-6442

Provider Business Practice Location Address
First Line	:	315 S MAIN ST
Second Line	:
City	:	WEBSTER SPRINGS
State	:	WV
Zip	:	26288-1123
Country	:	US
Telephone Number	:	304-847-5638
Fax Number	:	304-847-2538

Authorized Official
Title or Position	:	MEDICAID SPECIALIST
Name	:	MS. BILLIE JEAN RADER
Credential	:
Telephone Number	:	304-872-6440

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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