Provider Demographics
NPI:1598763666
Name:GRANT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GRANT MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILVET
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-257-1026
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1019
Mailing Address - Country:US
Mailing Address - Phone:304-257-1026
Mailing Address - Fax:304-257-1932
Practice Address - Street 1:117 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9566
Practice Address - Country:US
Practice Address - Phone:304-257-1026
Practice Address - Fax:304-257-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21275N00000X, 282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001375000Medicaid
WV3810016182Medicaid
WV51Z316Medicare Oscar/Certification
WV510026Medicare Oscar/Certification
WV3810016182Medicaid
WV5100Z6Medicare Oscar/Certification