=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942397153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTHA JEFFERSON HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 PETER JEFFERSON PKWY 3RD FLOOR
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-982-8520
-----------------------------------------------------
Fax | 434-982-8530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 PETER JEFFERSON PKWY 3RD FLOOR
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-982-8520
-----------------------------------------------------
Fax | 434-982-8530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/COO
-----------------------------------------------------
Name | ELLIOT H KUIDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-982-7326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------