Provider Demographics
NPI:1871633727
Name:CAMDEN ON GAULEY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CAMDEN ON GAULEY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-226-5725
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CAMDEN ON GAULEY
Mailing Address - State:WV
Mailing Address - Zip Code:26208-0069
Mailing Address - Country:US
Mailing Address - Phone:304-226-5725
Mailing Address - Fax:304-226-3274
Practice Address - Street 1:10003 WEBSTER ROAD
Practice Address - Street 2:
Practice Address - City:CAMDEN ON GAULEY
Practice Address - State:WV
Practice Address - Zip Code:26208-0000
Practice Address - Country:US
Practice Address - Phone:304-226-5725
Practice Address - Fax:304-226-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV035736291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5197060OtherAETNA
WV0035222006Medicaid
WV001709708OtherMS BCBS
WV51D0017142OtherCLIA-CAMDEN
WVCC5506OtherRR MEDICARE
WVCC5506OtherRR MEDICARE
WV0035222006Medicaid
WV511897Medicare Oscar/Certification
WV001709708OtherMS BCBS
WV5197060OtherAETNA