1124842786 NPI number — POTOMAC VALLEY HOSPITAL OF W VA , INC

Table of content: AMIE GAIL POSTMA FNP (NPI 1720353154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124842786 NPI number — POTOMAC VALLEY HOSPITAL OF W VA , INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTOMAC VALLEY HOSPITAL OF W VA , 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:
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:
1124842786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 PIN OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYSER
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26726-5908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-597-3510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
537 S MINERAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEYSER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26726-2936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-788-1274
Provider Business Practice Location Address Fax Number:
304-788-5154
Provider Enumeration Date:
11/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BOUCOT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
304-597-3510

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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