Provider Demographics
NPI:1346523206
Name:POCAHONTAS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:POCAHONTAS MEMORIAL HOSPITAL
Other - Org Name:POCAHONTAS MEMORIAL HOSPITAL MEDICAL PRACTICE RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:STARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-799-7400
Mailing Address - Street 1:150 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:WV
Mailing Address - Zip Code:24924
Mailing Address - Country:US
Mailing Address - Phone:304-799-6200
Mailing Address - Fax:304-799-6636
Practice Address - Street 1:150 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924
Practice Address - Country:US
Practice Address - Phone:304-799-6200
Practice Address - Fax:304-799-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023879Medicaid
WV3810023879Medicaid
WV=========OtherTAX ID