NPIMap

Organization Active NPI

Marietta Memorial Hospital of Tyler County Inc

Doing business as Dept of Primary Care 424

  • Rural Health Clinic/Center
  • Williamstown, WV
National Provider Identifier
1972302388
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Doing business as
Dept of Primary Care 424
Practice address
424 Highland Ave
Williamstown, WV 26187-1249
Phone
(740) 568-4190
Fax
(740) 568-4195
NPI assigned
Mar 10, 2025
Last updated
Apr 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

424 Highland Ave
Williamstown, WV 26187-1249

Mailing address

314 S Wells St
Sistersville, WV 26175-1098

Other names 1

  • Dept of Primary Care 424 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

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
O20250421002345 WV Part A Provider - Rural Health Clinic 4385055342 Practice locations: Williamstown, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972302388. Details of each certification follow.

Rural health clinic certification: CCN 513437

Legal name
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Doing business as
DEPT OF PRIMARY CARE 424
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 7, 2025
Last certification
Jul 7, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
424 Highland Ave
Williamstown, WV 26187-1249
Related CCNs
511304

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0932212Marietta Memorial Hospital of Tyler County, Inc424 Highland Ave, Williamstown, WV 26187Certificate of waiverAug 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Marietta Memorial Hospital of Tyler County Inc6 organizations share this tax ID, including this one
Part of
Marietta Memorial Hospital of Tyler County Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

111 Lafayette St
Ste 101
Saint Marys, WV 26170
Phone (304) 447-2498

242 Oxford St
Sistersville, WV 26175
Phone (304) 652-2611

305 Clay St
Sistersville, WV 26175
Phone (304) 447-2038

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Barengo Individual Operational/Managerial ControlDirector Jan 1, 2014
Sheryl Holdren Individual Operational/Managerial ControlDirector Jan 1, 2017
Terry E Rataiczak Individual Operational/Managerial ControlDirector Jan 1, 2019
Carol a Schneeberger Individual Operational/Managerial ControlTreasurer Jan 1, 2020
Michael Iaderosa Individual Operational/Managerial ControlDirector Oct 1, 2002
Victoria McGee Individual W-2 Managing EmployeeProvider Enrollment Supervisor May 1, 2014
Joseph D Cooper Individual Operational/Managerial ControlDirector Jan 1, 2003
Rebekah Gilden Individual W-2 Managing EmployeeCompliance & Privacy Specialist Jun 1, 2011
Paul G Westbrock Individual Corporate OfficerCompliance Officer Jun 1, 2000
Colleen Cook Individual Operational/Managerial ControlDirector Jan 1, 2010
Elizabeth a Helmick Individual Operational/Managerial ControlDirector Feb 1, 2021
Christopher Alexander Cockerham Individual Operational/Managerial ControlDirector Jan 1, 2020
Thomas Danford Individual Operational/Managerial ControlSecretary Jan 1, 2005
Matthew Pottmeyer Individual Operational/Managerial ControlDirector Jan 1, 2024
Hugh Sherman Individual Operational/Managerial ControlDirector Jan 1, 2024
Michael Archer Individual Operational/Managerial ControlPast Chairperson Jan 1, 2005
Gregg M Emerick Individual Operational/Managerial ControlVice Chairperson Jan 1, 2019
Stephen C Keiser Individual Operational/Managerial ControlChairperson Jan 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sistersville General Hospital Swing Bed UnitSistersville, WV, CCN 51Z304 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1741564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743465600000",
    "number": "1972302388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 HIGHLAND AVE",
            "city": "WILLIAMSTOWN",
            "state": "WV",
            "postal_code": "261871249",
            "telephone_number": "740-568-4190",
            "fax_number": "740-568-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC",
        "enumeration_date": "2025-03-10",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dept of Primary Care 424",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamstown, WV

Sources for this page

Verify at the official NPI Registry.