Provider Demographics
NPI:1861696601
Name:MERCER COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:MERCER COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:KADAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-324-8367
Mailing Address - Street 1:978 BLUE PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-5074
Mailing Address - Country:US
Mailing Address - Phone:304-324-8367
Mailing Address - Fax:304-324-8843
Practice Address - Street 1:978 BLUE PRINCE RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-5074
Practice Address - Country:US
Practice Address - Phone:304-324-8367
Practice Address - Fax:304-324-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001711297OtherBLUE CROSS BLUE SHIELD
WV1540381OtherUMWA PROVIDER NUMBER
WV0021320000Medicaid
WV1540381OtherUMWA PROVIDER NUMBER