NPIMap

Potomac Valley Hospital of W VA, Inc

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Keyser, WV

NPI 1770536112 · NPPES record last updated Jul 29, 2014

Key facts

NPI
1770536112
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
02 (WV)
Legal business name
POTOMAC VALLEY HOSPITAL OF W VA, INC
Practice address
100 Pin Oak LN
Keyser, WV 26726-5908
Phone
(304) 597-3510
Fax
(304) 597-3507
NPI assigned
May 18, 2006
Organization subpart
No

Authorized official

Name
Mr. Linda K Shroyer
Title
Administrator
Phone
(304) 597-3510

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 52

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 52

Practitioners 90

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 90

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WV

Hospital certification: CCN 51Z315

Legal name
POTOMAC VALLEY HOSPITAL OF W VA , INC
Organization structure
Corporation · Non-profit
Incorporated
Jul 1, 1958 in WV
Enrollment address
100 Pin Oak Lane
Keyser, WV 26726-2643
Hospital Swing-Bed Unit

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jerry E Whisner
Individual 		Corporate Director Sep 1, 2017
Michael Joseph Gould
Individual 		Corporate Director Aug 10, 2021
Marjorie S Fridkin
Individual 		Corporate Director Sep 21, 2023
Kevin Clark
Individual 		Corporate Director Mar 27, 2018
Dinah Courrier
Individual 		Corporate Director Nov 20, 2019
Lewis Kitzmiller
Individual 		Corporate Director Jul 20, 2022
West Virginia United Health System, Inc
Organization · Morgantown, WV
Non-profit 		Operational/Managerial Control Jan 1, 2005
Mark Boucot
Individual 		Corporate Director Jan 1, 2018
W-2 Managing Employee
President		 Jan 1, 2018
Harshad S Bokil
Individual 		Corporate Director Sep 21, 2023
Frances L Jones
Individual 		Corporate Director Nov 27, 2018
Sue a Wells
Individual 		W-2 Managing Employee
Sr Dir Prov Supp Services		 Apr 3, 2014
Robin Haupt
Individual 		Corporate Director Sep 1, 2017

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070226000745 WV Part a Provider - Critical Access Hospital 8123917788 Practice locations: Keyser, WV

National Provider Directory

Tax ID family
Potomac Valley Hospital of WV Inc (28 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 02 WV Yes

Addresses

Primary practice location

100 Pin Oak LN
Keyser, WV 26726-5908

Mailing address

100 Pin Oak LN
Keyser, WV 26726-5908
Phone (304) 597-3500

Other identifiers

IdentifierTypeStateIssuer
3810000637MedicaidWV

Other names

  • POTOMAC VALLEY HOSPITAL SWING BED Doing business as

Other providers in Keyser, WV

All providers in Keyser, WV · Medicare Defined Swing Bed Hospital Unit in West Virginia

Sources for this page

Verify at the official NPI Registry.