Provider Demographics
NPI:1093221103
Name:POTOMAC VALLEY HOSPITAL OF WV, INC.
Entity Type:Organization
Organization Name:POTOMAC VALLEY HOSPITAL OF WV, INC.
Other - Org Name:POTOMAC VALLEY HOSPITAL INTERNAL MEDICINE AND PULMONOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-597-3525
Mailing Address - Street 1:100 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-5908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 CARSKADON LN
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2123
Practice Address - Country:US
Practice Address - Phone:304-788-6655
Practice Address - Fax:304-788-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty