Provider Demographics
NPI:1780360255
Name:BOONE MEMORIAL HOSPITAL, INC
Entity type:Organization
Organization Name:BOONE MEMORIAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-369-1230
Mailing Address - Street 1:701 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1699
Mailing Address - Country:US
Mailing Address - Phone:304-369-1230
Mailing Address - Fax:
Practice Address - Street 1:6952 COAL RIVER RD
Practice Address - Street 2:SUITE A
Practice Address - City:COMFORT
Practice Address - State:WV
Practice Address - Zip Code:25049
Practice Address - Country:US
Practice Address - Phone:304-837-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONE MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy