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General NPI Number Information
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NPI Number | 1548246622
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Entity Type | Organization
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Legal Business Name | BROADDUS HOSPITAL ASSOCIATION, INC.
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | #1 HEALTHCARE DRIVE MANSFIELD HILL
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City | PHILIPPI
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State | WV
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Zip | 26416
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Country | US
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Telephone | 304-457-1760
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Fax | 304-457-1516
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Provider Business Mailing Address
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Address Line | #1 HEALTHCARE DRIVE P.O. BOX 930
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City | PHILIPPI
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State | WV
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Zip | 26416
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Country | US
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Telephone | 304-457-1760
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Fax | 304-457-1516
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Authorized Official
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Title or Position | CEO
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Name | MRS. DANA L. GOULD
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Credential |
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Telephone | 304-457-8155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 96
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License Number State | WV
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