Healthcare Provider Details

I. General information

NPI: 1912979873
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIN OAK LN
KEYSER WV
26726-5908
US

IV. Provider business mailing address

100 PIN OAK LANE
KEYSER WV
26726-2643
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3525
  • Fax: 304-597-3536
Mailing address:
  • Phone: 304-597-3525
  • Fax: 304-597-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number02
License Number StateWV

VIII. Authorized Official

Name: MR. HAROLD A MCBEE SR.
Title or Position: OWNER
Credential:
Phone: 410-643-3393