Basic Information
| Provider Information | |||||||||
| NPI: | 1508465162 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC | ||||||||
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| OtherOrganizationName: | SISTERSVILLE GENERAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O PAUL WESTBROCK | ||||||||
| Address2: | 314 S WELLS ST | ||||||||
| City: | SISTERSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046522611 | ||||||||
| FaxNumber: | 3046521448 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 FAIR ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBOURNE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261499525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047585000 | ||||||||
| FaxNumber: | 3047585022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2020 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | WESTBROCK | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, LEGAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 7403741581 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.