Healthcare Provider Details

I. General information

NPI: 1053693697
Provider Name (Legal Business Name): CHARLESTON AREA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 808
CHARLESTON WV
25304-1233
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 808
CHARLESTON WV
25304-1233
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2320
  • Fax: 304-388-2310
Mailing address:
  • Phone: 304-388-2320
  • Fax: 304-388-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number20
License Number StateWV

VIII. Authorized Official

Name: STEPHEN ZECHARIAH BELL
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 304-388-6251