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General NPI Number Information
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NPI Number | 1104242569
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Entity Type | Organization
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Legal Business Name | JEFFERSON MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 300 S PRESTON ST
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City | RANSON
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State | WV
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Zip | 25438-1631
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Country | US
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Telephone | 304-728-1669
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Fax | 304-725-9492
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Provider Business Mailing Address
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Address Line | PO BOX 1170
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City | MORGANTOWN
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State | WV
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Zip | 26507-1170
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Country | US
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Telephone | 304-264-1358
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Fax | 304-260-1480
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | ANTHONY P. ZELENKA
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Credential |
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Telephone | 304-264-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State |
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