Provider Demographics
NPI:1831283381
Name:ALUM CREEK MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ALUM CREEK MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-756-9001
Mailing Address - Street 1:2150 CHILDRESS ROAD
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-2150
Mailing Address - Country:US
Mailing Address - Phone:304-756-9001
Mailing Address - Fax:304-756-2081
Practice Address - Street 1:2150 CHILDRESS ROAD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003
Practice Address - Country:US
Practice Address - Phone:304-756-9001
Practice Address - Fax:304-756-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042109000Medicaid
WV001710389OtherBLUE CROSS BLUE SHIELD
WVE73971Medicare UPIN
WV9255211Medicare ID - Type Unspecified