Basic Information
| Provider Information | |||||||||
| NPI: | 1831373497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHEELING HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433000 | ||||||||
| FaxNumber: | 3042433078 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433000 | ||||||||
| FaxNumber: | 3042433078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2007 | ||||||||
| LastUpdateDate: | 12/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | VIOLI | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3042433000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHEELING HOSPITAL, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0001131002 | 05 | WV | MEDICAID |