1942397153 NPI number — MARTHA JEFFERSON HOSPITAL

Table of content: (NPI 1942397153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942397153 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:
1942397153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
595 PETER JEFFERSON PKWY
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-982-8520
Provider Business Mailing Address Fax Number:
434-982-8530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 PETER JEFFERSON PKWY
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-982-8520
Provider Business Practice Location Address Fax Number:
434-982-8530
Provider Enumeration Date:
10/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUIDA
Authorized Official First Name:
ELLIOT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
VP/COO
Authorized Official Telephone Number:
434-982-7326

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 186753 . This is a "ANTHEM SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com