Healthcare Provider Details

I. General information

NPI: 1841230661
Provider Name (Legal Business Name): PRESTON MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MEMORIAL DR
KINGWOOD WV
26537
US

IV. Provider business mailing address

150 MEMORIAL DR
KINGWOOD WV
26537
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-1400
  • Fax: 304-329-1175
Mailing address:
  • Phone: 304-329-1400
  • Fax: 304-329-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number56
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number56
License Number StateWV
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number56
License Number StateWV

VIII. Authorized Official

Name: MRS. MELISSA LOCKWOOD
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 304-329-1400