Healthcare Provider Details

I. General information

NPI: 1639278518
Provider Name (Legal Business Name): BRAXTON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 RIVER ST
GASSAWAY WV
26624-1137
US

IV. Provider business mailing address

100 HOYLMAN DR
GASSAWAY WV
26624-9321
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-2401
  • Fax:
Mailing address:
  • Phone: 304-364-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number002
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number031428
License Number StateWV

VIII. Authorized Official

Name: KIMBERLY D KNIGHT
Title or Position: CFO
Credential:
Phone: 304-364-1128