Organization
CAMDEN ON GAULEY MEDICAL CENTER INC
Active
Other names
Central WV Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH LYNN HAMRICK (ADMINISTRATOR)
(304) 226-5725
Entity
Organization
Contact information
Practice address
55 FRIENDS R FUN DR, SUMMERSVILLE, WV 26651-9514
(304) 872-1663
(304) 872-1804
Mailing address
PO BOX 69, CAMDEN ON GAULEY, WV 26208-0069
(304) 226-5725
(304) 226-3274
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709708
MS BCBS
WV
05
—
0035222000
—
WV
05
—
3810014298
—
WV
01
—
5197060
AETNA
WV
01
—
CC5506
RR MEDICARE
WV
Enumeration date
01/10/2006
Last updated
11/18/2010
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