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General NPI Number Information
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NPI Number | 1194287565
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Entity Type | Organization
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Legal Business Name | STATE OF WEST VIRGINIA CONCORD UNIVERSITY
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1000 VERMILLION ST
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City | ATHENS
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State | WV
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Zip | 24712-9027
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Country | US
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Telephone | 304-384-7325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | ATHENS
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State | WV
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Zip | 24712-1000
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Country | US
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Telephone | 304-384-5608
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH SERVICES
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Name | DR. HUGH DAVID CAMPBELL
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Credential | PHD
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Telephone | 304-384-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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