Provider Demographics
NPI:1396920138
Name:ALUM CREEK MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:ALUM CREEK MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-756-9001
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:2150 CHILDRESS ROAD
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-0040
Mailing Address - Country:US
Mailing Address - Phone:304-756-9001
Mailing Address - Fax:304-756-2081
Practice Address - Street 1:2150 CHILDRESS ROAD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-0040
Practice Address - Country:US
Practice Address - Phone:304-756-9001
Practice Address - Fax:304-756-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0007788001Medicaid
WVAL9255211Medicare PIN
WVE05089Medicare UPIN