Provider Demographics
NPI:1134518186
Name:CHARLESTON AREA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CHARLESTON AREA MEDICAL CENTER, INC.
Other - Org Name:CAMC PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-388-6251
Mailing Address - Street 1:3415 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-9700
Mailing Address - Fax:304-388-9795
Practice Address - Street 1:3415 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1334
Practice Address - Country:US
Practice Address - Phone:304-388-9700
Practice Address - Fax:304-388-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVMP05524173336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149739OtherPK