Provider Demographics
NPI:1821096637
Name:GRANT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GRANT MEMORIAL HOSPITAL
Other - Org Name:MT TOP MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-1026
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1019
Mailing Address - Country:US
Mailing Address - Phone:304-257-1026
Mailing Address - Fax:304-257-1932
Practice Address - Street 1:STATE ROUTE 55W
Practice Address - Street 2:
Practice Address - City:MT STORM
Practice Address - State:WV
Practice Address - Zip Code:26739
Practice Address - Country:US
Practice Address - Phone:304-693-7616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001375018Medicaid
WV9326621Medicare ID - Type UnspecifiedMT TOP MEDICAL CENTER