Basic Information
| Provider Information | |||||||||
| NPI: | 1821621632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POCAHONTAS MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 DUNCAN RD | ||||||||
| Address2: | |||||||||
| City: | BUCKEYE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249249037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047997400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 57 DUNCAN RD | ||||||||
| Address2: | |||||||||
| City: | BUCKEYE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249249044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047991075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | STARCHER | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | RUTH | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 3047997400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | POCAHONTAS MEMORIAL HOSPITAL | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.