Provider Demographics
NPI:1376700047
Name:TAMMY GROVE HAMILTON, LLC
Entity Type:Organization
Organization Name:TAMMY GROVE HAMILTON, LLC
Other - Org Name:MARTINSBURG FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:304-267-9355
Mailing Address - Street 1:1000 TAVERN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2864
Mailing Address - Country:US
Mailing Address - Phone:304-267-9355
Mailing Address - Fax:304-267-9358
Practice Address - Street 1:1000 TAVERN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2864
Practice Address - Country:US
Practice Address - Phone:304-267-9355
Practice Address - Fax:304-267-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33330 CERT-F0906082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty