Provider Demographics
NPI:1801057807
Name:CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-2202
Mailing Address - Street 1:800 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5340
Mailing Address - Country:US
Mailing Address - Phone:304-424-2111
Mailing Address - Fax:304-424-2853
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2111
Practice Address - Fax:304-424-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV13142OtherCARELINK MEDICAID HMO
1537181OtherUNITED MINE WORKERS
57038OtherMETROPOLITAN LIFE
395282OtherBLACK LUNG
333916OtherGOV'T EMP. HOSP. ASSOC.
OH1252602Medicaid
001705070OtherBLUE CROSS
124467100OtherFEDERAL COMPENSATION
333916OtherALLIANCE/MAMSI INSURANCE
N180OtherHEALTH PLAN
WV0001155005Medicaid
N180OtherHEALTH PLAN
333916OtherGOV'T EMP. HOSP. ASSOC.
1537181OtherUNITED MINE WORKERS