1528491537 NPI number — CAMDEN ON GAULEY MEDICAL CENTER, INC

Table of content: (NPI 1528491537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528491537 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:
1528491537
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:
100 SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRAIGSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26205-8572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-742-1061
Provider Business Mailing Address Fax Number:
304-742-1063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAIGSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26205-8572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-742-1061
Provider Business Practice Location Address Fax Number:
304-742-1063
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  2289-2571 , 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: 3910005736 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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