Healthcare Provider Details

I. General information

NPI: 1609842251
Provider Name (Legal Business Name): POCAHONTAS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number16
License Number StateWV

VIII. Authorized Official

Name: SHANNON RUTH STARCHER
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 304-799-7400