MEDICARE: PRINCETON MEMORIAL HOSPITAL COMPANY

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	314000000X	Skilled Nursing Facility	126	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841291960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON MEMORIAL HOSPITAL COMPANY

Provider Business Mailing Address
First Line	:	RR 1 BOX 101A
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951-9612
Country	:	US
Telephone Number	:	304-753-4332
Fax Number	:	304-753-4334

Provider Business Practice Location Address
First Line	:	JAMES MONROE DR AND US RT 219
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951
Country	:	US
Telephone Number	:	304-753-4332
Fax Number	:	304-753-4334

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PATRICK A SMITH
Credential	:	NHA CEO
Telephone Number	:	304-425-3203

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/22/2020

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