Provider Demographics
NPI:1487863833
Name:HEALTH MANAGEMENT ASSOCIATES OF WV
Entity Type:Organization
Organization Name:HEALTH MANAGEMENT ASSOCIATES OF WV
Other - Org Name:CARDIAC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-235-0466
Mailing Address - Street 1:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-1958
Mailing Address - Country:US
Mailing Address - Phone:304-235-0466
Mailing Address - Fax:304-235-0536
Practice Address - Street 1:61 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3530
Practice Address - Country:US
Practice Address - Phone:304-235-8999
Practice Address - Fax:304-235-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6578Medicare ID - Type UnspecifiedKY MEDICARE GROUP NUMBER