1275504508 NPI number — WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275504508 NPI number — WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

Employer Identification Number (EIN):

Provider Organization Name:

WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

UNIVERSITY HEALTH ASSOCIATES

Provider Other Organization Name Type Code:

3

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:

1275504508

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

02/10/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 780

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MORGANTOWN

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

26507-0780

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-293-7401

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1 MEDICAL CENTER DRIVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MORGANTOWN

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

26506

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-598-4800

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

01/26/2006

Authorized Official Last Name:

GIBSON

Authorized Official First Name:

JUSTIN

Authorized Official Middle Name:

Authorized Official Title or Position:

VP FINANCE-NORTHERN REGION

Authorized Official Telephone Number:

304-598-4256

• Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 51D0661844 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 51D0670497 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 51D0679009 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 5360003000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 0007379580003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0011526000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 51D1024856 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 906151700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 51D1005552 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 51D0995704 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 910478000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 0007384008 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 51D0236626 . This is a "CLIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: CA7030 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".