1871633727 NPI number — CAMDEN ON GAULEY MEDICAL CENTER INC

Table of content: (NPI 1871633727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871633727 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:
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:
1871633727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 69
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN ON GAULEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26208-0069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-226-5725
Provider Business Mailing Address Fax Number:
304-226-3274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10003 WEBSTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN ON GAULEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26208-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-226-5725
Provider Business Practice Location Address Fax Number:
304-226-3274
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMRICK
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
304-226-5725

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  035736 , 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: 5197060 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0035222006 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001709708 . This is a "MS BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51D0017142 . This is a "CLIA-CAMDEN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: CC5506 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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