Provider Demographics
NPI:1275558017
Name:CENTRAL WV MEDCORP, INC.
Entity type:Organization
Organization Name:CENTRAL WV MEDCORP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-637-3156
Mailing Address - Street 1:PO BOX 2630
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-637-3736
Mailing Address - Fax:304-637-3369
Practice Address - Street 1:11 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2231
Practice Address - Country:US
Practice Address - Phone:304-472-1600
Practice Address - Fax:304-472-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 207RG0300X, 208000000X
WV207P00000X, 207Q00000X, 207R00000X, 207Y00000X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010990Medicaid
WV000897320OtherMT ST BCBS GROUP NUMBER
WV151585801OtherDOL FEDERAL BLACK LUNG PR
WV001710531OtherMT ST BCBS PAC PAY TO #
WV020935300OtherDOL FEDERAL BLACK LUNG PR
WV0009078000Medicaid
WV020935302OtherDOL FEDERAL BLACK LUNG PR
WV020935300OtherDOL FEDERAL BLACK LUNG PR
WV020935300OtherDOL FEDERAL BLACK LUNG PR
WVCE9277346Medicare PIN
WVCE9356173Medicare PIN
WV51-3916Medicare PIN
WVCE9277345Medicare PIN
WV151585801OtherDOL FEDERAL BLACK LUNG PR
WV001710531OtherMT ST BCBS PAC PAY TO #
WV3810010990Medicaid
WVCE9277341Medicare PIN
WVCE9277349Medicare PIN
WVCE9277347Medicare PIN
WVCE9277343Medicare PIN