Healthcare Provider Details

I. General information

NPI: 1164228094
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 PLAZA DR
KEYSER WV
26726-6015
US

IV. Provider business mailing address

139 PLAZA DR
KEYSER WV
26726
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3455
  • Fax:
Mailing address:
  • Phone: 304-597-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUE A WELLS
Title or Position: SR DIR OF PROVIDER SERVICES
Credential:
Phone: 304-597-3525