Provider Demographics
NPI:1699704254
Name:CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:CAMDEN CLARK MEMORIAL HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-2202
Mailing Address - Street 1:800 GARFIELD AVE
Mailing Address - Street 2:P O BOX 718
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5340
Mailing Address - Country:US
Mailing Address - Phone:304-424-2111
Mailing Address - Fax:304-424-2853
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2111
Practice Address - Fax:304-424-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001155000Medicaid
OH1252602Medicaid
124467100OtherFEDERAL COMPENSATION
1537181OtherUNITED MINE WORKERS
333916OtherALLIANCE/MAMSI INSURANCE
57038OtherMETROPOLITAN LIFE
N180OtherHEALTH PLAN
WV13142Medicaid
395282OtherBLACK LUNG
333916OtherGOV'T. EMP. HOSP. ASSOC.
000301325OtherBLUE CROSS
N180OtherHEALTH PLAN
WV0001155000Medicaid
N180OtherHEALTH PLAN