Healthcare Provider Details

I. General information

NPI: 1194812727
Provider Name (Legal Business Name): HERBERT J. THOMAS MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

IV. Provider business mailing address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-3536
  • Fax: 304-766-4315
Mailing address:
  • Phone: 304-766-3536
  • Fax: 304-766-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number39
License Number StateWV

VIII. Authorized Official

Name: MS. DEONNA DANIELLE DIAMOND
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 304-766-3536