Provider Demographics
NPI:1841221561
Name:CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:CAMDEN-CLARK MEMORIAL HOSPITAL CORPORATION
Other - Org Name:CAMDEN CLARK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-2111
Mailing Address - Street 1:POST OFFICE BOX 718
Mailing Address - Street 2:800 GARFIELD AVENUE
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102-0718
Mailing Address - Country:US
Mailing Address - Phone:304-424-2111
Mailing Address - Fax:304-424-2853
Practice Address - Street 1:800 GARFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5378
Practice Address - Country:US
Practice Address - Phone:304-424-2111
Practice Address - Fax:304-424-2853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMDEN-CLARK HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
333916OtherGOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION
333916OtherGOV'T EMP. HOSP. ASSOC.
1252602OtherOHIO DEPARTMENT OF JOBS AND FAMILY SERVICES
N180OtherHEALTH PLAN
001741795OtherBLUE CROSS
124467100OtherFED COMP
OH1252602Medicaid
333916OtherALLIANCE/MAMSI INS.
WV0001155000Medicaid
039528299OtherFED COMP/ENERGY EMP OCC ILLNESS
124467100OtherFEDERAL WORKERS COMP.
333916OtherALLIANCE/MAMSI INSURANCE
001741795OtherBLUE CROSS
039528299OtherFED COMP/ENERGY EMP OCC ILLNESS
333916OtherGOV'T EMP. HOSP. ASSOC.
333916OtherGOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION
WV=========00OtherWORKERS COMPENSATION
N180OtherHEALTH PLAN
WV0001155000Medicaid