Basic Information
| Provider Information | |||||||||
| NPI: | 1710540968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHEELING HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
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| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
| FaxNumber: | 3042431131 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 16TH ST | ||||||||
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| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402380212 | ||||||||
| FaxNumber: | 7402380215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | RIESMEYER | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3042433124 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.