Provider Demographics
NPI:1467090449
Name:POTOMAC VALLEY HOSPITAL OF W VA , INC
Entity Type:Organization
Organization Name:POTOMAC VALLEY HOSPITAL OF W VA , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF CLINIC OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-597-3525
Mailing Address - Street 1:1370 JOHNSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1492
Mailing Address - Country:US
Mailing Address - Phone:681-342-3453
Mailing Address - Fax:304-842-2333
Practice Address - Street 1:100 PIN OAK LN STE 3
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-5908
Practice Address - Country:US
Practice Address - Phone:304-597-3790
Practice Address - Fax:304-597-3564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY HOSPITAL OF W VA , INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health