Healthcare Provider Details

I. General information

NPI: 1790608891
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PLAZA DR
KEYSER WV
26726-6015
US

IV. Provider business mailing address

147 PLAZA DRIVE
KEYSER WV
26726-6015
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-2404
  • Fax: 304-597-2403
Mailing address:
  • Phone: 304-597-2404
  • Fax: 304-597-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

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