Basic Information
Provider Information | |||||||||
NPI: | 1356522783 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OHIO VALLEY MEDICAL CENTER, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2000 EOFF ST | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260033823 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042348663 | ||||||||
FaxNumber: | 3042348960 | ||||||||
Practice Location | |||||||||
Address1: | 2211 EOFF ST | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260033807 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042173080 | ||||||||
FaxNumber: | 3042173108 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2007 | ||||||||
LastUpdateDate: | 02/23/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WARD | ||||||||
AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
AuthorizedOfficialMiddleName: | SUE | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
AuthorizedOfficialTelephone: | 3042348663 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 05 | WV | N |   | Hospitals | General Acute Care Hospital |   | 273R00000X | 05 | WV | Y |   | Hospital Units | Psychiatric Unit |   |
ID Information
ID | Type | State | Issuer | Description | 0001419002 | 05 | WV |   | MEDICAID |