Healthcare Provider Details

I. General information

NPI: 1902444987
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10261 FRANKFORT HWY
FORT ASHBY WV
26719-4533
US

IV. Provider business mailing address

1370 JOHNSON AVE STE 102
BRIDGEPORT WV
26330-1492
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3600
  • Fax: 304-285-3963
Mailing address:
  • Phone: 681-342-3453
  • Fax: 304-824-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUE A WELLS
Title or Position: SENIOR DIRECTOR OF CLINIC OPERATION
Credential:
Phone: 304-597-3525