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Braxton County Memorial Hospital

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

NPI 1861580334 · NPPES record last updated Nov 20, 2018

Key facts

NPI
1861580334
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
03 (WV)
Legal business name
BRAXTON COUNTY MEMORIAL HOSPITAL
Practice address
100 Hoylman Dr
Gassaway, WV 26624-9321
Phone
(304) 364-5156
Fax
(304) 364-5809
NPI assigned
Oct 10, 2006
Organization subpart
No

Authorized official

Name
Kimberly Dawn Knight
Title
Cfo
Phone
(304) 364-1128

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 2

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

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 118

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

View all 118

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 51Z308

Legal name
BRAXTON COUNTY MEMORIAL HOSPITAL
Organization structure
Corporation · Non-profit
Enrollment address
100 Hoylman Dr
Gassaway, WV 26624-9318
Hospital Swing-Bed Unit

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Michael C. Tillman
Individual 		Corporate Director
Board Member		 Jan 1, 2019
Sally Howard
Individual 		Corporate Director
Board Member		 Jul 7, 2007 12.5%
Deborah Burge
Individual 		W-2 Managing Employee
MGR ENT Patient Fin SVCS		 Jun 1, 2021
Richard Facemire
Individual 		Corporate Director
Board Member		 Jun 30, 2011 12.5%
West Virginia United Health System, Inc
Organization · Morgantown, WV
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Lawrence Boggs
Individual 		Corporate Director
Board Member		 Jul 1, 2007 12.5%
Louis G Roe
Individual 		Corporate Director
President/Ceo		 Jul 6, 2021
W-2 Managing Employee
President/Ceo		 Jul 6, 2021
Timothy Sodaro
Individual 		Corporate Director
Board Member		 Jul 1, 2007 12.5%
Stephanie Lea Frame
Individual 		Corporate Director
DO		 Jul 1, 2016
Barbara Adams
Individual 		Corporate Director
Board Member		 Jul 1, 2007 12.5%
Kimberly Knight
Individual 		Corporate Officer
Cfo		 Jan 1, 2014 12.5%
W-2 Managing Employee
Cfo		 Apr 4, 2014 12.5%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Braxton Community Health Center
Gassaway, WV · CCN 513400		 Rural health clinic 5% Or Greater Direct Ownership Interest (43%)
5% Or Greater Security Interest (57%)		 Jul 7, 2007
Jul 1, 2007

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20220908003440 WV Part a Provider - Critical Access Hospital 5193717759 Practice locations: Gassaway, WV

National Provider Directory

Locations

617 River St
Gassaway, WV 26624
Phone (304) 364-2401

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 03 WV Yes

Addresses

Primary practice location

100 Hoylman Dr
Gassaway, WV 26624-9321

Mailing address

100 Hoylman Dr
Gassaway, WV 26624-9321
Phone (304) 364-5156

Other names

  • Braxton County Memorial Hospital Doing business as

Other providers in Gassaway, WV

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

Sources for this page

Verify at the official NPI Registry.