Provider Demographics
NPI:1043259229
Name:BRAXTON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BRAXTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-364-1128
Mailing Address - Street 1:100 HOYLMAN DR
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-9321
Mailing Address - Country:US
Mailing Address - Phone:304-364-1063
Mailing Address - Fax:304-364-8637
Practice Address - Street 1:100 HOYLMAN DR
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-9321
Practice Address - Country:US
Practice Address - Phone:304-364-1063
Practice Address - Fax:304-364-8637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAXTON COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001703819OtherBLUE CROSS
WV306997OtherFEDERAL BLACK LUNG
WV0001734001Medicaid
WV=========002OtherTRICARE
WV=========002OtherTRICARE