Healthcare Provider Details

I. General information

NPI: 1891722377
Provider Name (Legal Business Name): JEFFERSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S. PRESTON STREET
RANSON WV
25438-1631
US

IV. Provider business mailing address

PO BOX 1170
MORGANTOWN WV
26507-1170
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-1600
  • Fax: 304-725-9492
Mailing address:
  • Phone: 304-598-6795
  • Fax: 304-598-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number103
License Number StateWV

VIII. Authorized Official

Name: KATHLEEN R QUINONES
Title or Position: INTERIM VP FINANCE
Credential:
Phone: 304-260-1443