Basic Information
| Provider Information | |||||||||
| NPI: | 1144228305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REYNOLDS MEMORIAL HOSPITAL,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | GLEN DALE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260381660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048453211 | ||||||||
| FaxNumber: | 3048433202 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | GLEN DALE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260381660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048453211 | ||||||||
| FaxNumber: | 3048433202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | HESS | ||||||||
| AuthorizedOfficialFirstName: | DAVD | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3048453211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 63 | WV | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0001309000 | 05 | WV | MEDICAID |