Healthcare Provider Details

I. General information

NPI: 1477559433
Provider Name (Legal Business Name): STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HOSPITAL PLZ
WESTON WV
26452-8558
US

IV. Provider business mailing address

230 HOSPITAL PLZ
WESTON WV
26452-8558
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-8000
  • Fax: 304-269-8090
Mailing address:
  • Phone: 304-269-8000
  • Fax: 304-269-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number510038
License Number StateWV

VIII. Authorized Official

Name: MR. C RICHARD SCHERICH
Title or Position: VP OF FINANCE
Credential:
Phone: 304-269-8050