NPIMap

Organization Active NPI

Marietta Memorial Hospital of Tyler County Inc

  • Family Medicine Physician
  • Sistersville, WV
National Provider Identifier
1144800673
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
May 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul G Westbrock
Title
VP, Legal Affairs
Phone
(740) 374-1581

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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 1

  • Professional Services Group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1144800673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O PAUL WESTBROCK",
            "address_2": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "26175",
            "telephone_number": "740-374-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-652-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "WESTBROCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP, LEGAL AFFAIRS",
        "authorized_official_telephone_number": "740-374-1581"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Services Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sistersville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.