Healthcare Provider Details

I. General information

NPI: 1215394648
Provider Name (Legal Business Name): CAMDEN ON GAULEY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 RED OAK DR
CRAIGSVILLE WV
26205-3102
US

IV. Provider business mailing address

46 RED OAK DR
CRAIGSVILLE WV
26205-3102
US

V. Phone/Fax

Practice location:
  • Phone: 304-742-5999
  • Fax:
Mailing address:
  • Phone: 304-742-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARGARET HICKEY
Title or Position: CEO
Credential:
Phone: 304-226-5725