Provider Demographics
NPI:1831243930
Name:CHARLESTON AREA MEDICAL CENTER
Entity type:Organization
Organization Name:CHARLESTON AREA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-388-2536
Mailing Address - Street 1:800 PENNSYLVANIA AVE
Mailing Address - Street 2:CHILDREN'S MEDICINE CENTER
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3351
Mailing Address - Country:US
Mailing Address - Phone:304-388-2525
Mailing Address - Fax:304-388-2537
Practice Address - Street 1:800 PENNSYLVANIA AVE
Practice Address - Street 2:CHILDREN'S MEDICINE CENTER
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3351
Practice Address - Country:US
Practice Address - Phone:304-388-2525
Practice Address - Fax:304-388-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20979261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3003934000Medicaid
WVH80736Medicare UPIN