Provider Demographics
NPI:1760499016
Name:POTOMAC VALLEY HOSPITAL OF W VA, INC
Entity Type:Organization
Organization Name:POTOMAC VALLEY HOSPITAL OF W VA, INC
Other - Org Name:ELK GARDEN RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-597-3510
Mailing Address - Street 1:100 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-5908
Mailing Address - Country:US
Mailing Address - Phone:304-597-3510
Mailing Address - Fax:
Practice Address - Street 1:48 OAK STREET
Practice Address - Street 2:
Practice Address - City:ELK GARDEN
Practice Address - State:WV
Practice Address - Zip Code:26717
Practice Address - Country:US
Practice Address - Phone:304-446-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
513981Medicare Oscar/Certification