Healthcare Provider Details

I. General information

NPI: 1336199157
Provider Name (Legal Business Name): BOONE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MADISON AVE
MADISON WV
25130-1669
US

IV. Provider business mailing address

701 MADISON AVE
MADISON WV
25130-1669
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1230
  • Fax: 304-369-6036
Mailing address:
  • Phone: 304-369-1230
  • Fax: 304-369-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number119
License Number StateWV

VIII. Authorized Official

Name: MR. RANDELL DAVIS FOXX SR.
Title or Position: EXE. DIR., FIN. SER.
Credential: CFO
Phone: 304-369-1230