Provider Demographics
NPI:1124151071
Name:GRANT MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:GRANT MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANMETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-1026
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1019
Mailing Address - Country:US
Mailing Address - Phone:304-257-1026
Mailing Address - Fax:304-257-1932
Practice Address - Street 1:1 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847
Practice Address - Country:US
Practice Address - Phone:304-257-1026
Practice Address - Fax:304-257-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001375010Medicaid