Provider Demographics
NPI:1437249414
Name:TUCKER COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:TUCKER COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-478-3572
Mailing Address - Street 1:219 SUNNYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-1322
Mailing Address - Country:US
Mailing Address - Phone:304-478-3572
Mailing Address - Fax:304-478-3864
Practice Address - Street 1:219 SUNNYSIDE LN
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1322
Practice Address - Country:US
Practice Address - Phone:304-478-3572
Practice Address - Fax:304-478-3864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021398001Medicaid
WV0021398003Medicaid
WV0021398003Medicaid