Provider Demographics
NPI:1104035328
Name:HAMPSHIRE MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:HAMPSHIRE MEMORIAL HOSPITAL, INC.
Other - Org Name:HAMPSHIRE MEMORIAL HOSPITAL,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECHAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-536-5100
Mailing Address - Street 1:549 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1352
Mailing Address - Country:US
Mailing Address - Phone:304-822-4561
Mailing Address - Fax:304-822-7809
Practice Address - Street 1:363 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-4607
Practice Address - Country:US
Practice Address - Phone:304-822-4561
Practice Address - Fax:304-822-7809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMPSHIRE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV69207P00000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty