Provider Demographics
NPI:1003549643
Name:DAVIS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DAVIS MEMORIAL HOSPITAL
Other - Org Name:DAVIS SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-637-3622
Mailing Address - Street 1:812 GORMAN AVE
Mailing Address - Street 2:PO BOX 1484
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-637-3622
Mailing Address - Fax:
Practice Address - Street 1:812 GORMAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-637-3622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy