Basic Information
| Provider Information | |||||||||
| NPI: | 1780043372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHEELING HOSPITAL INC | ||||||||
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| OtherOrganizationName: | COLERAIN 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: | 260036379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
| FaxNumber: | 3042431131 | ||||||||
| Practice Location | |||||||||
| Address1: | 72562 STATE ROUTE 250 | ||||||||
| Address2: | |||||||||
| City: | DILLONVALE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407380020 | ||||||||
| FaxNumber: | 7407380625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2016 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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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 | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.