Provider Demographics
NPI:1891564761
Name:DAVIS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DAVIS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONRAD WILDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-637-3622
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1484
Mailing Address - Country:US
Mailing Address - Phone:304-637-3622
Mailing Address - Fax:
Practice Address - Street 1:11 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-4707
Practice Address - Country:US
Practice Address - Phone:304-472-1600
Practice Address - Fax:304-472-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health