Organization
CENTRAL WV MEDCORP, INC.
Active
Other names
Buckhannon Medical Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA JEAN HAMMER (CFO)
(304) 637-3156
Entity
Organization
Contact information
Practice address
11 N LOCUST ST, BUCKHANNON, WV 26201-2231
(304) 472-1600
(304) 472-6382
Mailing address
PO BOX 2630, ELKINS, WV 26241-2630
(304) 637-3736
(304) 637-3369
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
207P00000X
Emergency Medicine Physician
—
WV
207Q00000X
Family Medicine Physician
—
WV
207R00000X
Internal Medicine Physician
—
WV
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
207Y00000X
Otolaryngology Physician
—
WV
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
WV
2086S0129X
Vascular Surgery Physician
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000897320
MT ST BCBS GROUP NUMBER
WV
05
—
0009078000
—
WV
01
—
001710531
MT ST BCBS PAC PAY TO #
WV
01
—
020935300
DOL FEDERAL BLACK LUNG PR
WV
01
—
020935302
DOL FEDERAL BLACK LUNG PR
WV
01
—
151585801
DOL FEDERAL BLACK LUNG PR
WV
05
—
3810010990
—
WV
Enumeration date
07/13/2006
Last updated
10/31/2011
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