| 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 | 
|---|---|
| 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 | 
|---|---|
| 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 | 
|---|---|
| Provider Enumeration Date | 01/29/2025 | 
| Last Update Date | 01/29/2025 | 
| Medicare PECOS PAC ID | 6002867850 | 
|---|---|
| Medicare Enrollment ID | O20250225000088 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1972316479 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary | 
| Provider Name | Mindy L Bostic | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1871880856 PECOS PAC ID: 3577735638 Enrollment ID: I20111013000594 | 
| Provider Name | Kara M Holdren | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1033519558 PECOS PAC ID: 8224351465 Enrollment ID: I20141223000715 | 
| Provider Name | Jill Marie Johnson | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1821507492 PECOS PAC ID: 2668739525 Enrollment ID: I20171130002134 | 
| Provider Name | Paula Michelle Brammer | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1346599313 PECOS PAC ID: 8820462740 Enrollment ID: I20230316000384 | 
| Provider Name | Elizabeth Antoinette Brooke | 
|---|---|
| Provider Type | Practitioner - Mental Health Counselor | 
| Provider Identifiers | NPI Number: 1659894509 PECOS PAC ID: 9133481898 Enrollment ID: I20240401003100 |