Healthcare Provider Details

I. General information

NPI: 1942503164
Provider Name (Legal Business Name): CITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 N TENNESSEE AVE STE 104
MARTINSBURG WV
25401-9401
US

IV. Provider business mailing address

PO BOX 6866
WHEELING WV
26003-0923
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-5160
  • Fax: 304-596-5161
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GROVER GLENDON KERNS
Title or Position: VP OF FINANCE
Credential:
Phone: 304-260-1443