Provider Demographics
NPI:1790745172
Name:HOSPITAL DEVELOPMENT CO
Entity Type:Organization
Organization Name:HOSPITAL DEVELOPMENT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
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:304-927-6819
Mailing Address - Fax:304-927-6837
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1050
Practice Address - Country:US
Practice Address - Phone:304-927-6819
Practice Address - Fax:304-927-6837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROANE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-28
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0123058001Medicaid
WV513990Medicare Oscar/Certification
WVHO5113061Medicare ID - Type UnspecifiedMEDICARE PART B GRP NUMBE