Provider Demographics
NPI:1841291960
Name:PRINCETON MEMORIAL HOSPITAL COMPANY
Entity type:Organization
Organization Name:PRINCETON MEMORIAL HOSPITAL COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA CEO
Authorized Official - Phone:304-425-3203
Mailing Address - Street 1:RR 1 BOX 101A
Mailing Address - Street 2:
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951-9612
Mailing Address - Country:US
Mailing Address - Phone:304-753-4332
Mailing Address - Fax:304-753-4334
Practice Address - Street 1:JAMES MONROE DR AND US RT 219
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951
Practice Address - Country:US
Practice Address - Phone:304-753-4332
Practice Address - Fax:304-753-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV126314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010087000Medicaid
WV51-5188Medicare ID - Type Unspecified