Healthcare Provider Details

I. General information

NPI: 1235068354
Provider Name (Legal Business Name): REYNOLDS MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WHEELING AVE
GLEN DALE WV
26038-1536
US

IV. Provider business mailing address

PO BOX 616
MORGANTOWN WV
26507-0616
US

V. Phone/Fax

Practice location:
  • Phone: 304-221-3012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLASS EDWARD HARRISON
Title or Position: PRESIDENT
Credential:
Phone: 304-243-3263