Basic Information
| Provider Information | |||||||||
| NPI: | 1316023450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHEELING HOSPITAL INC | ||||||||
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| OtherOrganizationName: | SHADYSIDE HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK BUSINESS OFFICE NTTC | ||||||||
| Address2: | JANICE RIESMEYER | ||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
| FaxNumber: | 3042431131 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | SHADYSIDE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439471209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406719357 | ||||||||
| FaxNumber: | 7406719739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | RIESMEYER | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3042433124 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHEELING HOSPITAL INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.