Basic Information
Provider Information | |||||||||
NPI: | 1104821305 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WHEELING HOSPITAL INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 MEDICAL PARK | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260036379 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042433000 | ||||||||
FaxNumber: | 3042433060 | ||||||||
Practice Location | |||||||||
Address1: | 1 MEDICAL PARK | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 26003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042433124 | ||||||||
FaxNumber: | 3042436343 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2005 | ||||||||
LastUpdateDate: | 07/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RIESMEYER | ||||||||
AuthorizedOfficialFirstName: | JANICE | ||||||||
AuthorizedOfficialMiddleName: | ELAINE | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
AuthorizedOfficialTelephone: | 3042433124 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 89 | WV | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 0001131002 | 05 | WV |   | MEDICAID | 9384750 | 05 | OH |   | MEDICAID | 5100501 | 01 | WV | MEDICARE PART B | OTHER | 0001131000 | 05 | WV |   | MEDICAID | 300047 | 01 | WV | BLACK LUNG PROVIDER NUMBE | OTHER | 001742046 | 01 | WV | MOUNTAIN STATE BLUE CROSS SKILLED | OTHER |