Healthcare Provider Details

I. General information

NPI: 1093917643
Provider Name (Legal Business Name): PRINCETON COMMUNITY HOSPITAL ASSN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 12TH STREET
PRINCETON WV
24740
US

IV. Provider business mailing address

118 12TH STREET
PRINCETON WV
24740
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-7936
  • Fax: 304-487-7835
Mailing address:
  • Phone: 304-487-7936
  • Fax: 304-487-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number10308
License Number StateWV

VIII. Authorized Official

Name: DIANE LYNN SPENCER
Title or Position: VP OF FINANCE/CFO
Credential:
Phone: 304-487-7505