Basic Information
| Provider Information | |||||||||
| NPI: | 1033347414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | E. A. HAWSE HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 97 | ||||||||
| Address2: | |||||||||
| City: | BAKER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 268010097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048975915 | ||||||||
| FaxNumber: | 3048976216 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S GROVE ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 268471770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042572451 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3048975915 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 122300000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 124Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dental Hygienist | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.