Provider Demographics
NPI:1821018177
Name:CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-2202
Mailing Address - Street 1:800 GARFIELD AVE
Mailing Address - Street 2:P O BOX 718
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5340
Mailing Address - Country:US
Mailing Address - Phone:304-424-2111
Mailing Address - Fax:304-424-2853
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2111
Practice Address - Fax:304-424-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001155100Medicaid
556009259OtherCARELINK
700056OtherBLACK LUNG
WV0001155104Medicaid
1537181OtherUNITED MINE WORKERS
N180OtherHEALTH PLAN
333916OtherALLIANCE/MAMSI INS.
333916OtherGOV'T. EMP. HOSP. ASSOC.
00174882OtherBLUE CROSS
OH2034604Medicaid
OH=========01OtherWORKERS COMPENSATION
OH2034604Medicaid
511509AMedicare ID - Type UnspecifiedMEDICARE