NPIMap

Organization Active NPI

Potomac Valley Hospital of W VA, Inc

Doing business as Potomac Valley Hospital Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Keyser, WV
National Provider Identifier
1770536112
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
02 Issued in WV
Legal business name
POTOMAC VALLEY HOSPITAL OF W VA, INC
Doing business as
Potomac Valley Hospital Swing Bed
Practice address
100 Pin Oak LN
Keyser, WV 26726-5908
Phone
(304) 597-3510
Fax
(304) 597-3507
NPI assigned
May 18, 2006
Last updated
Jul 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • POTOMAC VALLEY HOSPITAL SWING BED Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770536112. Details of each certification follow.

Hospital certification: CCN 51Z315

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

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Potomac Valley Hospital of W VA Inc28 organizations share this tax ID, including this one

Other organizations with this 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.

Ownership & related parties

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 EmployeePresident 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 EmployeeSr Dir Prov Supp Services Apr 3, 2014
Robin Haupt Individual Corporate Director Sep 1, 2017

Owners & managing parties with NPI records 3

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1770536112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PIN OAK LN",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267265908",
            "telephone_number": "304-597-3500",
            "fax_number": "304-597-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PIN OAK LN",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267265908",
            "telephone_number": "304-597-3510",
            "fax_number": "304-597-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC VALLEY HOSPITAL OF W VA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "SHROYER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "304-597-3510",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WV",
            "license": "02",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTOMAC VALLEY HOSPITAL SWING BED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keyser, WV

Sources for this page

Verify at the official NPI Registry.