Healthcare Provider Details

I. General information

NPI: 1700058054
Provider Name (Legal Business Name): HOPE MEDICAL CENTER LAB CRAIGSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 RED OAK DR
CRAIGSVILLE WV
26205-3102
US

IV. Provider business mailing address

PO BOX 946
CRAIGSVILLE WV
26205-0946
US

V. Phone/Fax

Practice location:
  • Phone: 304-742-5737
  • Fax: 304-742-5738
Mailing address:
  • Phone: 304-742-5737
  • Fax: 304-742-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWV

VIII. Authorized Official

Name: MARK HARDWAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-742-5737