MEDICARE: POCAHONTAS MEMORIAL HOSPITAL

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1972136786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCAHONTAS MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	150 DUNCAN RD
Second Line	:
City	:	BUCKEYE
State	:	WV
Zip	:	24924-9037
Country	:	US
Telephone Number	:	304-799-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	16023 CASS RD
Second Line	:
City	:	CASS
State	:	WV
Zip	:	24927-9136
Country	:	US
Telephone Number	:	681-206-7100
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	SHANNON RUTH STARCHER
Credential	:
Telephone Number	:	304-799-7400

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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Directions to “POCAHONTAS MEMORIAL HOSPITAL ” Practice Location

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