Provider Demographics
NPI:1396026134
Name:CAMDEN CLARK HOSPITAL
Entity Type:Organization
Organization Name:CAMDEN CLARK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-2227
Mailing Address - Street 1:3420 MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010124207R00000X
WV2552282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty