MEDICARE: CHARLESTON AREA MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1518579689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON AREA MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1547
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25326-1547
Country	:	US
Telephone Number	:	304-388-1724
Fax Number	:	304-388-1721

Provider Business Practice Location Address
First Line	:	702 PROFESSIONAL PARK DR STE 102
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2033
Country	:	US
Telephone Number	:	304-872-0035
Fax Number	:	304-872-0102

Authorized Official
Title or Position	:	VP FINANCE
Name	:	STEPHEN ZECHARIAH BELL
Credential	:
Telephone Number	:	304-388-6251

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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