Provider Demographics
NPI:1720157043
Name:CABELL HUNTINGTON HOSPITAL
Entity Type:Organization
Organization Name:CABELL HUNTINGTON HOSPITAL
Other - Org Name:CABELL HUNTINGTON HOSPITAL HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-526-2075
Mailing Address - Street 1:1340 HAL GREER BLVD
Mailing Address - Street 2:HOME HEALTH DEPARTMENT
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-526-2075
Mailing Address - Fax:304-526-2006
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:HOME HEALTH DEPARTMENT
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-526-2075
Practice Address - Fax:304-526-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVOP0551174332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001144006Medicaid
WV001745289OtherMOUNTAIN ST. BCBS PROV #
WV0640090001Medicare NSC