1437420213 NPI number — MARTHA JEFFERSON HOSPITAL

Table of content: (NPI 1437420213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437420213 NPI number — MARTHA JEFFERSON HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA JEFFERSON 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:
Provider Other Organization Name Type Code:
6
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:
1437420213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MARTHA JEFFERSON DR
Provider Second Line Business Mailing Address:
BOX G288
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22911-4668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-654-3348
Provider Business Mailing Address Fax Number:
434-654-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MARTHA JEFFERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-4668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-654-3348
Provider Business Practice Location Address Fax Number:
434-654-3353
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BURRIS
Authorized Official First Name:
J. MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
434-654-7305

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0201004441 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1437420213 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2133540 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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