Basic Information
| Provider Information | |||||||||
| NPI: | 1518068014 | ||||||||
| 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: | 09/26/2006 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | HESS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3048453211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207ZB0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZC0500X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZH0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZM0300X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 2085B0100X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 207PE0004X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 0001309002 | 05 | WV | MEDICAID |