MEDICARE: CHARLESTON MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	231H00000X	Audiologist
2	208600000X	Surgery Physician
3	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1174479513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	211 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1445
Country	:	US
Telephone Number	:	304-900-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1445
Country	:	US
Telephone Number	:	304-900-5511
Fax Number	:

Authorized Official
Title or Position	:	PAYER ENROLLMENT REPRESENTATIVE
Name	:	GINGER PETERS
Credential	:
Telephone Number	:	304-388-0112

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “CHARLESTON MEDICAL CENTER, INC. ” Practice Location

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