Provider Demographics
NPI:1891826285
Name:BRAXTON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BRAXTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:BCMH SURGICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:304-364-1153
Mailing Address - Street 1:100 HOYLMAN DR
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-9321
Mailing Address - Country:US
Mailing Address - Phone:304-364-1153
Mailing Address - Fax:304-364-1154
Practice Address - Street 1:100 HOYLMAN DR
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-9321
Practice Address - Country:US
Practice Address - Phone:304-364-1153
Practice Address - Fax:304-364-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4006002000Medicaid
WVBR5113081Medicare ID - Type UnspecifiedMEDICARE PART B