Provider Demographics
NPI:1275974008
Name:CENTRAL WV MEDCORP, INC
Entity Type:Organization
Organization Name:CENTRAL WV MEDCORP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-637-3156
Mailing Address - Street 1:911 GORMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3082
Mailing Address - Country:US
Mailing Address - Phone:304-637-6302
Mailing Address - Fax:304-637-6307
Practice Address - Street 1:911 GORMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3082
Practice Address - Country:US
Practice Address - Phone:304-637-6302
Practice Address - Fax:304-637-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV69937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty