Healthcare Provider Details

I. General information

NPI: 1174040265
Provider Name (Legal Business Name): CHARLESTON AREA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 KANAWHA AVE SW STE 200
SOUTH CHARLESTON WV
25309-1367
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 203
CHARLESTON WV
25304-1228
US

V. Phone/Fax

Practice location:
  • Phone: 304-205-7992
  • Fax: 304-205-7739
Mailing address:
  • Phone: 304-388-1724
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1035-7147
License Number StateWV

VIII. Authorized Official

Name: STEPHEN Z. BELL
Title or Position: VICE PRESIDENT - FINANCE
Credential:
Phone: 304-388-6251