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General NPI Number Information
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NPI Number | 1568765964
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Entity Type | Organization
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Legal Business Name | CHARLESTON AREA MEDICAL CENTER
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1227
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Country | US
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Telephone | 304-388-9086
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Fax | 304-388-4729
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Provider Business Mailing Address
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Address Line | 3208 VIRGINIA AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1208
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Country | US
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Telephone | 304-549-0684
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Fax | 304-388-4729
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. JAMES BOLAND
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Credential | M.D.
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Telephone | 304-347-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 64613
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License Number State | WV
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