Healthcare Provider Details

I. General information

NPI: 1922149046
Provider Name (Legal Business Name): GRANT MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DRIVE
PETERSBURG WV
26847
US

IV. Provider business mailing address

PO BOX 1019
PETERSBURG WV
26847-1019
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-1026
  • Fax: 304-257-1932
Mailing address:
  • Phone: 304-257-1026
  • Fax: 304-257-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDY M MICHAELS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 304-257-1026