Basic Information
| Provider Information | |||||||||
| NPI: | 1306046750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OHIO VALLEY GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776161 | ||||||||
| FaxNumber: | 4127776838 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776161 | ||||||||
| FaxNumber: | 4127776838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 08/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | PROVENZANO | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4127776280 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OHIO VALLEY GENERAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | FACHE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1007502820014 | 05 | PA | MEDICAID | 000000056035 | 01 | PA | UNISON | OTHER |