Provider Demographics
NPI:1770048043
Name:DAVIS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DAVIS MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-637-3196
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1484
Mailing Address - Country:US
Mailing Address - Phone:304-636-3300
Mailing Address - Fax:304-637-3867
Practice Address - Street 1:812 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-636-3300
Practice Address - Fax:304-637-3867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-31
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit