Basic Information
| Provider Information | |||||||||
| NPI: | 1790824233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHEELING HOSPITAL INC | ||||||||
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| OtherOrganizationName: | WHEELING HOSPITAL INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433880 | ||||||||
| FaxNumber: | 3042433895 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 MEDICAL PARK STE 401 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433880 | ||||||||
| FaxNumber: | 3042433895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | MURDY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3042433681 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 |
ID Information
| ID | Type | State | Issuer | Description | 0001131008 | 05 | WV | MEDICAID |