Basic Information
Provider Information
NPI: 1124029400
EntityType: 2
ReplacementNPI:  
OrganizationName: MINNIE HAMILTON HEALTH CARE CENTER, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CRITICAL ACCESS HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 186 HOSPITAL DRIVE
Address2:  
City: GRANTSVILLE
State: WV
PostalCode: 261477100
CountryCode: US
TelephoneNumber: 3043549244
FaxNumber: 3043549323
Practice Location
Address1: 186 HOSPITAL DRIVE
Address2:  
City: GRANTSVILLE
State: WV
PostalCode: 261477100
CountryCode: US
TelephoneNumber: 3043549244
FaxNumber: 3043549323
Other Information
ProviderEnumerationDate: 08/09/2005
LastUpdateDate: 04/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WHITED
AuthorizedOfficialFirstName: STEPHEN
AuthorizedOfficialMiddleName: S.
AuthorizedOfficialTitleorPosition: CFO/COO
AuthorizedOfficialTelephone: 3043549244
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC0060X150WVY HospitalsGeneral Acute Care HospitalCritical Access

ID Information
IDTypeStateIssuerDescription
000217600005WV MEDICAID


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