Healthcare Provider Details

I. General information

NPI: 1063228120
Provider Name (Legal Business Name): HOSPITALIST MEDICINE PHYSICIANS OF WEST VIRGINIA - SOUTH CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 12TH ST
PRINCETON WV
24740-2312
US

IV. Provider business mailing address

120 BRENTWOOD COMMONS WAY STE 510
BRENTWOOD TN
37027-2028
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-7000
  • Fax:
Mailing address:
  • Phone: 855-768-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FALL
Title or Position: MANAGER
Credential:
Phone: 253-682-6040