Basic Information
| Provider Information | |||||||||
| NPI: | 1356392732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHEELING HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VISITING NURSE SERVICES OF WHEELING HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
| FaxNumber: | 3042431131 | ||||||||
| Practice Location | |||||||||
| Address1: | 58 16TH STREET | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042434663 | ||||||||
| FaxNumber: | 3042435076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIESMEYER | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3042433124 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHEELING HOSPITAL INC | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0222459 | 05 | OH | MEDICAID | B007 | 01 | HEALTH PLAN OHIO VALLEY | OTHER | 0001131004 | 05 | WV | MEDICAID | 000327331 | 01 | MT STATE BCBS | OTHER | 1046524 | 01 | WEST VIRGINIA WORKER COMP | OTHER |