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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