Healthcare Provider Details

I. General information

NPI: 1275558017
Provider Name (Legal Business Name): CENTRAL WV MEDCORP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N LOCUST ST
BUCKHANNON WV
26201-2231
US

IV. Provider business mailing address

PO BOX 2630
ELKINS WV
26241-2630
US

V. Phone/Fax

Practice location:
  • Phone: 304-472-1600
  • Fax: 304-472-6382
Mailing address:
  • Phone: 304-637-3736
  • Fax: 304-637-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateWV
# 5
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateWV
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateWV
# 9
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateWV

VIII. Authorized Official

Name: MS. REBECCA JEAN HAMMER
Title or Position: CFO
Credential:
Phone: 304-637-3156