Provider Demographics
NPI:1558340414
Name:CAMDEN ON GAULEY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CAMDEN ON GAULEY MEDICAL CENTER INC
Other - Org Name:CENTRAL WV COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-226-5725
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CAMDEN ON GAULEY
Mailing Address - State:WV
Mailing Address - Zip Code:26208-0069
Mailing Address - Country:US
Mailing Address - Phone:304-226-5725
Mailing Address - Fax:304-226-3274
Practice Address - Street 1:55 FRIENDS R FUN DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9514
Practice Address - Country:US
Practice Address - Phone:304-872-1663
Practice Address - Fax:304-872-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035222000Medicaid
WV5197060OtherAETNA
WV3810014298Medicaid
WV001709708OtherMS BCBS
WVCC5506OtherRR MEDICARE
WV5119411Medicare PIN
WV5118971Medicare PIN
WV5197060OtherAETNA
WV001709708OtherMS BCBS
WVCC5506OtherRR MEDICARE
WV511897Medicare Oscar/Certification
WVD518361Medicare PIN