Provider Demographics
NPI:1962816470
Name:CHARLESTON AREA MEDICAL CENTER
Entity Type:Organization
Organization Name:CHARLESTON AREA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGY-1 RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HUFTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-399-3819
Mailing Address - Street 1:2004 MULBERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-6552
Mailing Address - Country:US
Mailing Address - Phone:636-399-3819
Mailing Address - Fax:
Practice Address - Street 1:3110 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1210
Practice Address - Country:US
Practice Address - Phone:304-388-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1083967282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural