Basic Information
| Provider Information | |||||||||
| NPI: | 1558313213 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRINCETON COMMUNITY HOSPITAL ASSN., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1369 | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247401369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044877000 | ||||||||
| FaxNumber: | 3044877370 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 12TH STREET EXT | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044877000 | ||||||||
| FaxNumber: | 3044877370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 07/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | SINICROPE | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3044877263 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 104 | WV | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0001110000 | 05 | WV | MEDICAID | 0001111001 | 05 | WV | MEDICAID | 0001111002 | 05 | WV | MEDICAID | 0150460 | 05 | DC | MEDICAID | 01690544 | 05 | KY | MEDICAID | 005100461 | 05 | VA | MEDICAID | 092732500 | 05 | FL | MEDICAID | 10180B | 05 | SC | MEDICAID | 010065000 | 05 | MD | MEDICAID | 0233590 | 05 | OH | MEDICAID | 0350460 | 05 | DC | MEDICAID | 5100046 | 05 | NC | MEDICAID | 00931939 | 05 | NY | MEDICAID | 10175A | 05 | SC | MEDICAID | 0008205350001 | 05 | PA | MEDICAID |