Healthcare Provider Details

I. General information

NPI: 1477360584
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PLAZA DR
KEYSER WV
26726-6015
US

IV. Provider business mailing address

145 PLAZA DR
KEYSER WV
26726-6015
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3545
  • Fax:
Mailing address:
  • Phone: 304-597-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUE A WELLS
Title or Position: SENIOR DIRECTOR PROVIDER SUPPORT
Credential:
Phone: 304-597-3525