Basic Information
| Provider Information | |||||||||
| NPI: | 1093287302 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHEELING HOSPITAL AMBULATORY SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
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| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
| FaxNumber: | 3042436343 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 STATE ROUTE 7 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439121642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2018 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | RIESMEYER | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3042433124 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.