Healthcare Provider Details

I. General information

NPI: 1831234947
Provider Name (Legal Business Name): WVU HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26507-1127
US

IV. Provider business mailing address

PO BOX 1127
MORGANTOWN WV
26507-1127
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4032
  • Fax: 304-598-4143
Mailing address:
  • Phone: 304-598-4032
  • Fax: 304-598-4143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateWV

VIII. Authorized Official

Name: MR. BRUCE BOWMAN MCCLYMONDS
Title or Position: ADMINISTRATOR
Credential:
Phone: 304-598-4032