MEDICARE: POTOMAC VALLEY HOSPITAL OF W VA, 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	:	1760499016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTOMAC VALLEY HOSPITAL OF W VA, INC

Provider Business Mailing Address
First Line	:	100 PIN OAK LN
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-5908
Country	:	US
Telephone Number	:	304-597-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 OAK STREET
Second Line	:
City	:	ELK GARDEN
State	:	WV
Zip	:	26717
Country	:	US
Telephone Number	:	304-446-5505
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LINDA K SHROYER
Credential	:
Telephone Number	:	304-597-3510

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/06/2015

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