Healthcare Provider Details

I. General information

NPI: 1316054919
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIN OAK LANE
KEYSER WV
26726-2643
US

IV. Provider business mailing address

100 PIN OAK LN
KEYSER WV
26726-5908
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3500
  • Fax:
Mailing address:
  • Phone: 304-597-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SUE A WELLS
Title or Position: DIR PROV SUPPORT SERVICES
Credential:
Phone: 304-597-3525