Organization
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Active
Organization
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Active
Other names
Southern Local School District Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKI L KNICELY (BILLING/CREDENTIALING SUPERVISOR)
(304) 275-3301
Entity
Organization
Contact information
Practice address
920 ELM ST, RACINE, OH 45771-8902
(740) 949-2348
(740) 949-2536
Mailing address
PO BOX 609, ELIZABETH, WV 26143-0609
(304) 275-3301
(304) 275-4798
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085471
—
OH
Enumeration date
06/08/2010
Last updated
09/07/2023
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