Healthcare Provider Details

I. General information

NPI: 1104020163
Provider Name (Legal Business Name): POCAHONTAS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DUNCAN RD
BUCKEYE WV
24924-9037
US

IV. Provider business mailing address

150 DUNCAN RD
BUCKEYE WV
24924-9037
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-7400
  • Fax: 304-799-6636
Mailing address:
  • Phone: 304-799-7400
  • Fax: 304-799-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA LAY
Title or Position: CEO
Credential:
Phone: 304-799-7400