Healthcare Provider Details

I. General information

NPI: 1639135221
Provider Name (Legal Business Name): BOONE MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number119
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberIP0550770
License Number StateWV

VIII. Authorized Official

Name: DOUGLAS COLE MALCOLM
Title or Position: CFO
Credential:
Phone: 304-688-1823