1699704254 NPI number — CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION

Table of content: (NPI 1699704254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699704254 NPI number — CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMDEN CLARK MEMORIAL HOSPITAL 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's Other Name Information

Provider Other Organization Name:
CAMDEN CLARK MEDICAL CENTER
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 Information

NPI Number:
1699704254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 GARFIELD AVE
Provider Second Line Business Mailing Address:
P O BOX 718
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-424-2111
Provider Business Mailing Address Fax Number:
304-424-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 GARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-5340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-424-2111
Provider Business Practice Location Address Fax Number:
304-424-2853
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIERSON
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
304-424-2202

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  102 , 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: 0001155000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1252602 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124467100 . This is a "FEDERAL COMPENSATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1537181 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 333916 . This is a "ALLIANCE/MAMSI INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57038 . This is a "METROPOLITAN LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: N180 . This is a "HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13142 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 395282 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 333916 . This is a "GOV'T. EMP. HOSP. ASSOC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 000301325 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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