Organization
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Active
Other names
Jackson County School Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI L. KNICELY (BILLING/CREDENTIALING SUPERVISOR)
(304) 275-3301
Entity
Organization
Contact information
Practice address
4A SCHOOL ST, RIPLEY, WV 25271-1538
(304) 372-7341
(304) 372-7341
Mailing address
PO BOX 609, ELIZABETH, WV 26143-0609
(304) 275-3301
(304) 275-4798
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009486002
—
WV
Enumeration date
12/07/2007
Last updated
01/03/2014
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