Provider Demographics
NPI:1700058054
Name:HOPE MEDICAL CENTER LAB CRAIGSVILLE
Entity Type:Organization
Organization Name:HOPE MEDICAL CENTER LAB CRAIGSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-742-5737
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205-0946
Mailing Address - Country:US
Mailing Address - Phone:304-742-5737
Mailing Address - Fax:304-742-5738
Practice Address - Street 1:46 RED OAK DR
Practice Address - Street 2:
Practice Address - City:CRAIGSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26205-3102
Practice Address - Country:US
Practice Address - Phone:304-742-5737
Practice Address - Fax:304-742-5738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003446Medicaid
WV3810003446Medicaid