Camden On Gauley Medical Center Inc | |
1945 E Mount Lookout Rd Mount Lookout WV 26678-9304 | |
(043) 226-5725 | |
(304) 226-3274 |
Full Name | Camden On Gauley Medical Center Inc |
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Speciality | Clinic/Center |
Location | 1945 E Mount Lookout Rd, Mount Lookout, West Virginia |
Authorized Official Name and Position | Margaret Hickey (CEO) |
Authorized Official Contact | 3042265725 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Camden On Gauley Medical Center Inc 10003 Webster Rd Camden On Gauley WV 26208-7713 Ph: (043) 226-5725 | Camden On Gauley Medical Center Inc 1945 E Mount Lookout Rd Mount Lookout WV 26678-9304 Ph: (043) 226-5725 |
NPI Number | 1972316479 |
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Provider Enumeration Date | 01/29/2025 |
Last Update Date | 01/29/2025 |
Medicare PECOS PAC ID | 6002867850 |
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Medicare Enrollment ID | O20250225000088 |
Identifier | Type | State | Issuer |
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1972316479 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Mindy L Bostic |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871880856 PECOS PAC ID: 3577735638 Enrollment ID: I20111013000594 |
Provider Name | Kara M Holdren |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033519558 PECOS PAC ID: 8224351465 Enrollment ID: I20141223000715 |
Provider Name | Jill Marie Johnson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821507492 PECOS PAC ID: 2668739525 Enrollment ID: I20171130002134 |
Provider Name | Paula Michelle Brammer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346599313 PECOS PAC ID: 8820462740 Enrollment ID: I20230316000384 |
Provider Name | Elizabeth Antoinette Brooke |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1659894509 PECOS PAC ID: 9133481898 Enrollment ID: I20240401003100 |