Provider Demographics
NPI:1366762825
Name:WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Entity type:Organization
Organization Name:WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNICELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-275-3301
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:920 ELM ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:OH
Practice Address - Zip Code:45771-8902
Practice Address - Country:US
Practice Address - Phone:740-949-2348
Practice Address - Fax:740-949-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085471Medicaid
361971Medicare Oscar/Certification