Marietta Memorial Hospital of Tyler County Inc
Organization Active NPI Family Medicine Physician · Sistersville, WV
NPI 1144800673 · NPPES record last updated May 14, 2021
Key facts
- NPI
- 1144800673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
- Practice address
- 314 S Wells St
Sistersville, WV 26175-1098 - Phone
- (304) 652-2611
- NPI assigned
- Apr 9, 2021
- Organization subpart
- No
Authorized official
- Name
- Paul G Westbrock
- Title
- VP, Legal Affairs
- Phone
- (740) 374-1581
Other NPIs on the same Medicare enrollment 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210601001753 | WV | Part B Supplier - Clinic/Group Practice | 4385055342 |
Receives reassigned benefits from 45 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Middlebourne, WV; Saint Marys, WV; Sistersville, WV; Williamstown, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X |
Addresses
Primary practice location
314 S Wells St
Sistersville, WV 26175-1098
Mailing address
C/O Paul Westbrock
314 S Wells St
Sistersville, WV 26175
Phone (740) 374-1581
Other names
- Professional Services Group
Other providers in Sistersville, WV
- Brian Holmes
- Christopher Isaly
- Abigail Tamara Kerns
- Linda Liebold
- Amy Lynch
- Marietta Memorial Hospital of Tyler County Inc
- Marietta Memorial Hospital of Tyler County Inc
- Marietta Memorial Hospital of Tyler County Inc
- Marietta Memorial Hospital of Tyler County Inc
- Sandra Gorby Marody
All providers in Sistersville, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.