Provider Demographics
NPI:1790820835
Name:WEST VIRGINIA UNIVERSITY HOSPITALS, INC
Entity Type:Organization
Organization Name:WEST VIRGINIA UNIVERSITY HOSPITALS, INC
Other - Org Name:WVU CHESTNUT RIDGE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BOWMAN
Authorized Official - Last Name:MCCLYMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-598-4032
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:930 CHESTNUT RIDGE ROAD
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1127
Mailing Address - Country:US
Mailing Address - Phone:304-598-4032
Mailing Address - Fax:304-598-4143
Practice Address - Street 1:930 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2807
Practice Address - Country:US
Practice Address - Phone:304-598-4032
Practice Address - Fax:304-598-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0222014002Medicaid