Provider Demographics
NPI:1982875845
Name:HOPE MEDICAL CENTER LAB COWEN
Entity Type:Organization
Organization Name:HOPE MEDICAL CENTER LAB COWEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-226-5527
Mailing Address - Street 1:74 TECHNOLOGY LN
Mailing Address - Street 2:
Mailing Address - City:COWEN
Mailing Address - State:WV
Mailing Address - Zip Code:26206-3702
Mailing Address - Country:US
Mailing Address - Phone:304-226-5527
Mailing Address - Fax:304-226-5531
Practice Address - Street 1:74 TECHNOLOGY LN
Practice Address - Street 2:
Practice Address - City:COWEN
Practice Address - State:WV
Practice Address - Zip Code:26206-3702
Practice Address - Country:US
Practice Address - Phone:304-226-5527
Practice Address - Fax:304-226-5531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008870Medicaid
WV9357961Medicare PIN