1558313213 NPI number — PRINCETON COMMUNITY HOSPITAL ASSN., INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558313213 NPI number — PRINCETON COMMUNITY HOSPITAL ASSN., INC.

Employer Identification Number (EIN):

Provider Organization Name:

PRINCETON COMMUNITY HOSPITAL ASSN., 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 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:

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Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1558313213

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

12/08/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 1369

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PRINCETON

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

24740-1369

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-487-7000

Provider Business Mailing Address Fax Number:

304-487-7370

Provider First Line Business Practice Location Address:

122 12TH STREET EXT

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PRINCETON

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

24740-2352

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-487-7000

Provider Business Practice Location Address Fax Number:

304-487-7370

Provider Enumeration Date:

05/17/2006

Authorized Official Last Name:

SPENCER

Authorized Official First Name:

DIANE

Authorized Official Middle Name:

LYNN

Authorized Official Title or Position:

VP OF FINANCE/CFO

Authorized Official Telephone Number:

304-487-7505

• Taxonomy code: 282N00000X , with the licence number:  104 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 010065000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 005100461 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 00931939 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 10180B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 5100046 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 0001110000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 0001111002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 0233590 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 0001111001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 0008205350001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0350460 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
• Identifier: 092732500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 01690544 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 10175A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 0150460 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".