MEDICARE: GRANT MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245238237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANT MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1019
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-1019
Country	:	US
Telephone Number	:	304-257-1026
Fax Number	:	304-257-1932

Provider Business Practice Location Address
First Line	:	8 LEE ST
Second Line	:	SUITE 3
City	:	MOOREFIELD
State	:	WV
Zip	:	26836-1091
Country	:	US
Telephone Number	:	304-538-7707
Fax Number	:	304-538-7706

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	SANDY M MICHAELS
Credential	:
Telephone Number	:	305-257-1026

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/22/2020

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Directions to “GRANT MEMORIAL HOSPITAL ” Practice Location

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