Provider Demographics
NPI:1518480847
Name:WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Other - Org Name:WVU URGENT CARE - FAIRMONT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-285-7129
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-285-7101
Mailing Address - Fax:
Practice Address - Street 1:100 STONEY HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1589
Practice Address - Country:US
Practice Address - Phone:304-285-5400
Practice Address - Fax:304-285-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care