Healthcare Provider Details

I. General information

NPI: 1063649606
Provider Name (Legal Business Name): POTOMAC VALLEY HOSPITAL OF W VA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 ASHFIELD ST
PIEDMONT WV
26750-1300
US

IV. Provider business mailing address

100 PIN OAK LN
KEYSER WV
26726-5908
US

V. Phone/Fax

Practice location:
  • Phone: 304-355-2323
  • Fax:
Mailing address:
  • Phone: 304-597-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD A MCBEE
Title or Position: OWNER
Credential:
Phone: 410-643-3393