Healthcare Provider Details

I. General information

NPI: 1265221196
Provider Name (Legal Business Name): JEFFERSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 5TH AVE
RANSON WV
25438-1678
US

IV. Provider business mailing address

201 E 5TH AVE
RANSON WV
25438-1678
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-2165
  • Fax: 304-728-2168
Mailing address:
  • Phone: 304-728-2165
  • Fax: 304-728-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GROVER GLENDON KERNS
Title or Position: VP OF FINANCE
Credential:
Phone: 304-260-1443