Provider Demographics
NPI:1376967471
Name:CAMC URGENT CARE SOUTHRIDGE
Entity Type:Organization
Organization Name:CAMC URGENT CARE SOUTHRIDGE
Other - Org Name:CHARLESTON AREA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-388-6251
Mailing Address - Street 1:301 RHL STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8275
Mailing Address - Country:US
Mailing Address - Phone:304-388-7010
Mailing Address - Fax:304-388-7015
Practice Address - Street 1:301 RHL STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8275
Practice Address - Country:US
Practice Address - Phone:304-388-7010
Practice Address - Fax:304-388-7015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLESTON AREA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty