Organization
CAMDEN ON GAULEY MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARET E GROVES (ADMINISTRATOR)
(304) 226-5725
Entity
Organization
Contact information
Practice address
10003 WEBSTER RD, CAMDEN ON GAULEY, WV 26208-0069
(304) 226-5725
(304) 226-3274
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
01
—
001764303
MS BCBS
WV
05
—
0035222000
—
WV
01
—
5197060
AETNA
WV
01
—
51D0017142
CLIA-CAMDEN
WV
01
—
CC5506
RR MEDICARE
WV
Enumeration date
12/05/2005
Last updated
12/10/2021
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