MEDICARE: CAMC GREENBRIER VALLEY 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	:	1588485478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMC GREENBRIER VALLEY MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	400 ASSOCIATION DR STE 102
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 SENECA TRL S
Second Line	:
City	:	PETERSTOWN
State	:	WV
Zip	:	24963-5040
Country	:	US
Telephone Number	:	304-753-9100
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	CHAD HOVIS
Credential	:
Telephone Number	:	304-388-6251

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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