1649277476 NPI number — COMMUNITY HEALTH ASSOCIATION

Table of content: (NPI 1649277476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649277476 NPI number — COMMUNITY HEALTH ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH ASSOCIATION
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:
JACKSON GENERAL HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1649277476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 720
Provider Second Line Business Mailing Address:
122 PINNELL STREET
Provider Business Mailing Address City Name:
RIPLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25271-0720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-373-1477
Provider Business Mailing Address Fax Number:
304-372-2749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 PINNELL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25271-0720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-373-1477
Provider Business Practice Location Address Fax Number:
304-372-2749
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
304-373-1475

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  52 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 52 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 512320 . This is a "SWING BED" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 5100181 . This is a "MEDICARE- ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3910000963 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51-Z320 . This is a "SWING BED" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51U018 . This is a "SWING BED" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810023822 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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