1821489469 NPI number — BRAXTON COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1821489469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821489469 NPI number — BRAXTON COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAXTON COUNTY MEMORIAL HOSPITAL
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:
BRAXTON COUNTY MEMORIAL GROUP
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:
1821489469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOYLMAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASSAWAY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26624-9318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-364-5156
Provider Business Mailing Address Fax Number:
304-364-5809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOYLMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASSAWAY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26624-9318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-364-5156
Provider Business Practice Location Address Fax Number:
304-364-5809
Provider Enumeration Date:
02/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
304-364-1128

Provider Taxonomy Codes

  • Taxonomy code: 261QC0050X , with the licence number:  3 , 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)

  • Identifier: 4006002000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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