Healthcare Provider Details

I. General information

NPI: 1972316479
Provider Name (Legal Business Name): CAMDEN ON GAULEY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E MOUNT LOOKOUT RD
MOUNT LOOKOUT WV
26678-9304
US

IV. Provider business mailing address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

V. Phone/Fax

Practice location:
  • Phone: 43-226-5725
  • Fax: 304-226-3274
Mailing address:
  • Phone: 43-226-5725
  • Fax: 304-226-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARGARET HICKEY
Title or Position: CEO
Credential:
Phone: 304-226-5725