Provider Demographics
NPI:1639423411
Name:HOSPITAL DEVELOPMENT CO
Entity Type:Organization
Organization Name:HOSPITAL DEVELOPMENT CO
Other - Org Name:WALTON MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-927-6200
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1050
Mailing Address - Country:US
Mailing Address - Phone:304-927-4444
Mailing Address - Fax:304-927-6837
Practice Address - Street 1:94 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:WV
Practice Address - Zip Code:25286-9774
Practice Address - Country:US
Practice Address - Phone:304-577-6815
Practice Address - Fax:304-577-6816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROANE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-01
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV513417OtherPTAN
WV513417Medicare PIN
WV513417OtherPTAN