Provider Demographics
NPI:1639418361
Name:CAMDEN ON GAULEY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CAMDEN ON GAULEY MEDICAL CENTER, INC
Other - Org Name:CAMDEN FAMILY HEALTH (COWEN LOCATION)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-226-5725
Mailing Address - Street 1:56 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:COWEN
Mailing Address - State:WV
Mailing Address - Zip Code:26206-3702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 PARK STREET
Practice Address - Street 2:
Practice Address - City:COWEN
Practice Address - State:WV
Practice Address - Zip Code:26206-3702
Practice Address - Country:US
Practice Address - Phone:304-226-5275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMDEN ON GAULEY MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-31
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)