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General NPI Number Information
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NPI Number | 1396026134
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Entity Type | Organization
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Legal Business Name | CAMDEN CLARK HOSPITAL
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 800 GARFIELD AVE
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City | PARKERSBURG
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State | WV
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Zip | 26101-5340
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Country | US
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Telephone | 304-424-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 MARKET ST.
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City | STOCKPORT
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State | OH
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Zip | 43787
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESIDENCY COORDINATOR
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Name | TAMMY MAYHEW
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Credential |
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Telephone | 304-424-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34010124
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 2552
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License Number State | WV
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