Provider Demographics
NPI:1871784355
Name:GILMER COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:GILMER COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-462-7351
Mailing Address - Street 1:809 MEDICAL DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1274
Mailing Address - Country:US
Mailing Address - Phone:304-462-7351
Mailing Address - Fax:304-462-8956
Practice Address - Street 1:809 MEDICAL DR
Practice Address - Street 2:SUITE #3
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1274
Practice Address - Country:US
Practice Address - Phone:304-462-7351
Practice Address - Fax:304-462-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVFV94191Medicare PIN