Provider Demographics
NPI:1558313213
Name:PRINCETON COMMUNITY HOSPITAL ASSN., INC.
Entity Type:Organization
Organization Name:PRINCETON COMMUNITY HOSPITAL ASSN., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-7505
Mailing Address - Street 1:PO BOX 1369
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1369
Mailing Address - Country:US
Mailing Address - Phone:304-487-7000
Mailing Address - Fax:304-487-7370
Practice Address - Street 1:122 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2352
Practice Address - Country:US
Practice Address - Phone:304-487-7000
Practice Address - Fax:304-487-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010065000Medicaid
VA005100461Medicaid
NY00931939Medicaid
SC10180BMedicaid
NC5100046Medicaid
WV0001110000Medicaid
WV0001111002Medicaid
OH0233590Medicaid
WV0001111001Medicaid
PA0008205350001Medicaid
DC0350460Medicaid
FL092732500Medicaid
KY01690544Medicaid
SC10175AMedicaid
DC0150460Medicaid
DC0350460Medicaid
PA0008205350001Medicaid