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Organization

BRAXTON COUNTY MEMORIAL HOSPITAL

Active
Other names
Braxton Community Health Center
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY D KNIGHT (CFO)
(304) 364-1128
Entity
Organization

Contact information

Practice address
617 RIVER ST, GASSAWAY, WV 26624-1137
(304) 364-2401
Mailing address
100 HOYLMAN DR, GASSAWAY, WV 26624-9321
(304) 364-1093

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
002
WV
261QR1300X
Rural Health Clinic/Center
Primary
031428
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5360015000
WV
01
BR5113081
MEDICARE PART B GROUP #
WV
Enumeration date
09/21/2006
Last updated
07/21/2022
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