1174040265 NPI number — CHARLESTON AREA MEDICAL CENTER INC

Table of content: (NPI 1174040265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174040265 NPI number — CHARLESTON AREA MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLESTON AREA MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAMC CARDIOLOGY SOUTH CHARLESTON
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174040265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 MACCORKLE AVE SE STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25304-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-388-1724
Provider Business Mailing Address Fax Number:
304-388-1721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 KANAWHA AVE SW STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25309-1367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-205-7992
Provider Business Practice Location Address Fax Number:
304-205-7739
Provider Enumeration Date:
08/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Z.
Authorized Official Title or Position:
VICE PRESIDENT - FINANCE
Authorized Official Telephone Number:
304-388-6251

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  1035-7147 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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