Organization
GRANT MEMORIAL HOSPITAL
Active
Other names
Potomac Orthopedic Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY M MICHAELS (CHIEF FINANCIAL OFFICER)
(304) 257-1026
Entity
Organization
Contact information
Practice address
10 VALLEY VIEW ST, SUITE 101, PETERSBURG, WV 26847-9543
(304) 257-9785
(304) 257-9790
Mailing address
PO BOX 1019, PETERSBURG, WV 26847-1019
(304) 257-1026
(304) 257-1932
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0206987000
—
WV
Enumeration date
07/13/2005
Last updated
08/22/2020
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