Healthcare Provider Details

I. General information

NPI: 1639423411
Provider Name (Legal Business Name): HOSPITAL DEVELOPMENT CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 SCHOOL DR
WALTON WV
25286-9774
US

IV. Provider business mailing address

200 HOSPITAL DR
SPENCER WV
25276-1050
US

V. Phone/Fax

Practice location:
  • Phone: 304-577-6815
  • Fax: 304-577-6816
Mailing address:
  • Phone: 304-927-4444
  • Fax: 304-927-6837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74
License Number StateWV

VIII. Authorized Official

Name: DOUGLAS E BENTZ
Title or Position: CEO
Credential:
Phone: 304-927-6200