1174065916 NPI number — CAMDEN ON GAULEY MEDICAL CENTER INC

Table of content: (NPI 1174065916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174065916 NPI number — CAMDEN ON GAULEY MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMDEN ON GAULEY 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:
Provider Other Organization Name Type Code:
6
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:
1174065916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10003 WEBSTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN ON GAULEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26208-7713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-226-5725
Provider Business Mailing Address Fax Number:
304-226-3274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 PANTHER CREEK ELEMENTARY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NETTIE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26681-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-226-5725
Provider Business Practice Location Address Fax Number:
304-226-3274
Provider Enumeration Date:
11/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HICKEY
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-226-5725

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1174065916 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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