Provider Demographics
NPI:1316054919
Name:POTOMAC VALLEY HOSPITAL OF WVA, INC
Entity type:Organization
Organization Name:POTOMAC VALLEY HOSPITAL OF WVA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-597-3510
Mailing Address - Street 1:100 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-5908
Mailing Address - Country:US
Mailing Address - Phone:304-597-3500
Mailing Address - Fax:
Practice Address - Street 1:100 PIN OAK LANE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2643
Practice Address - Country:US
Practice Address - Phone:304-597-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000782Medicaid
WVPO5100612Medicare PIN