Healthcare Provider Details

I. General information

NPI: 1750343125
Provider Name (Legal Business Name): FAIRMONT GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 LOCUST AVE
FAIRMONT WV
26554-1435
US

IV. Provider business mailing address

1325 LOCUST AVE
FAIRMONT WV
26554-1435
US

V. Phone/Fax

Practice location:
  • Phone: 304-367-7100
  • Fax: 304-367-7294
Mailing address:
  • Phone: 304-367-7100
  • Fax: 304-367-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number09
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number09
License Number StateWV

VIII. Authorized Official

Name: MS. WHITNEY PATTERSON
Title or Position: CFO / VP OF FINANCE
Credential: CPA, CHFP
Phone: 304-367-7109