Healthcare Provider Details

I. General information

NPI: 1487439683
Provider Name (Legal Business Name): CHARLESTON AREA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 DRY HILL RD
BECKLEY WV
25801-2605
US

IV. Provider business mailing address

400 ASSOCIATION DR STE 102
CHARLESTON WV
25311-1298
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-6060
  • Fax: 304-253-6086
Mailing address:
  • Phone: 304-388-1724
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN LUZADER
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 304-388-0151