Healthcare Provider Details

I. General information

NPI: 1972610863
Provider Name (Legal Business Name): PRINCETON COMMUNITY HOSPITAL ASSN., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 VERMILLION ST.
ATHENS WV
24712
US

IV. Provider business mailing address

PO BOX 697
ATHENS WV
24712-0697
US

V. Phone/Fax

Practice location:
  • Phone: 304-384-7325
  • Fax: 304-384-8870
Mailing address:
  • Phone: 304-384-7325
  • Fax: 304-384-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20079
License Number StateWV

VIII. Authorized Official

Name: MR. OMAR R KASSEM
Title or Position: PHYSICIAN
Credential: MD
Phone: 304-384-7325