1477979102 NPI number — JEFFERSON MEMORIAL HOSPITAL

Table of content: (NPI 1477979102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477979102 NPI number — JEFFERSON MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JEFFERSON PHYSICAL THERAPY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477979102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 FOUNDATION WAY
Provider Second Line Business Mailing Address:
SUITE 2310
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25401-9003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-264-1358
Provider Business Mailing Address Fax Number:
304-260-1480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 SOMERSET BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401-3952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-728-1601
Provider Business Practice Location Address Fax Number:
304-725-3690
Provider Enumeration Date:
03/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
304-264-1358

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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