Camc Greenbrier Valley Medical Center Inc
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Ronceverte, WV
NPI 1487370540 · NPPES record last updated Oct 19, 2022
Key facts
- NPI
- 1487370540
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- CAMC GREENBRIER VALLEY MEDICAL CENTER INC
- Practice address
- 1320 Maplewood Avenue
Ronceverte, WV 24970-8016 - Phone
- (304) 647-6006
- Fax
- (304) 388-6782
- NPI assigned
- Oct 19, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- CAMC GREENBRIER VALLEY MEDICAL CENTER INC
Authorized official
- Name
- Mr. Chad Hovis
- Title
- VP Finance
- Phone
- (304) 388-6251
Owners & managing parties with NPI records 1
-
Glenn Crotty Jr., MD
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 3
Related certifications (CCN) 1
Facilities with the same owner 17
Practitioners 84
-
Jessica Cochran, CRNA
-
Stephanie Judy, CRNA
-
Brandon Slack Radow, M.D,
-
Constance L. Anderson, D.O.
-
David Angus, CRNA, DMP
-
Yuri Arvan, M.D.
-
John T Bartenslager, CRNA
-
Erin D Burns, PA-C
-
Taylor Burton, PA-C
-
Katie Carter, CRNA
-
Jefferson Patrick Casto, M.D.
-
David H Church, M.D.
-
Heather Marie Clawges, M.D.
-
Sandra L Cottle IV, CNM
-
Llew Alan Crowder, CRNA
-
Clinton E Curtis, MD
-
Nicholas Dakota Dailey, MS, LAT, ATC, PAC
-
Katherine V Dean, CRNA
-
Samuel Gray Deem, DO
-
Laurel Dottellis, CRNA
-
Michelle L Dudding, CRNA
Affiliated clinicians 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Hospital certification: CCN 51U002
- Legal name
- CAMC GREENBRIER VALLEY MEDICAL CENTER INC
- Organization structure
- Corporation · Proprietary
- Incorporated
- Sep 14, 2022 in WV
- Enrollment address
- 1320 Maplewood Ave
Ronceverte, WV 24970-8016 - Hospital subgroups
- Acute care, Swing-bed approved
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Glenn Crotty |
Corporate Director |
Jan 1, 2023 | |
| David L Ramsey |
Corporate Director |
Jan 1, 2023 | |
| Chad Hovis |
Corporate Director |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 | ||
| Vandalia Health Inc |
5% Or Greater Direct Ownership Interest | Sep 1, 2022 | 100% |
| Operational/Managerial Control | Sep 1, 2022 | 100% | |
| Jeffrey D Sandene |
Corporate Director |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230117001488 | WV | Part a Provider - Hospital | 1254702962 | Practice locations: Ronceverte, WV |
National Provider Directory
- Tax ID family
- Camc Greenbrier Valley Medical Center Inc
- Part of
- Camc Greenbrier Valley Medical Center Inc
Interoperability endpoints
- https://api.platform.athenahealth.com/27854/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
1320 Maplewood Avenue
Ronceverte, WV 24970-8016
Mailing address
501 Morris Street
Charleston, WV 25301-1326
Phone (304) 388-6251
Other providers in Ronceverte, WV
- Erin D Burns
- Matthew Burns
- Taylor Burton
- Albany Byers
- Laura Caldwell
- Camc Greenbrier Valley Medical Center Inc
- Camc Greenbrier Valley Medical Center Inc
- Camc Greenbrier Valley Medical Center, Inc.
- Camc Greenbrier Valley Medical Center, Inc.
- Sherri Camp
All providers in Ronceverte, WV · Medicare Defined Swing Bed Hospital Unit in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.