MEDICARE: WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	104100000X	Social Worker
3	101Y00000X	Counselor
4	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1194691428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 780
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26507-0780
Country	:	US
Telephone Number	:	304-598-4214
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SCOTT AVE
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-8803
Country	:	US
Telephone Number	:	304-598-4214
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	JUSTIN GIBSON
Credential	:
Telephone Number	:	304-598-4256

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	02/12/2026

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