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1275528614

NPI Code Detail

MEDICARE: WILLIAMSON MEMORIAL HOSPITAL LLC

MEDICARE: WILLIAMSON MEMORIAL HOSPITAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician
3	363LF0000X	Family Nurse Practitioner
4	282N00000X	General Acute Care Hospital	68	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	CK7099	OTHER		RAILROAD MC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	DA1751	OTHER		RAILROAD MC
8	DA7625	OTHER		RAILRAOD MC
9	CG2287	OTHER		RAILROAD MC

General Provider Information

NPI Number	:	1275528614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSON MEMORIAL HOSPITAL LLC

Provider Business Mailing Address
First Line	:	859 ALDERSON ST
Second Line	:	PO BOX 1980
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3215
Country	:	US
Telephone Number	:	304-235-2500
Fax Number	:	304-235-4549

Provider Business Practice Location Address
First Line	:	859 ALDERSON ST
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3215
Country	:	US
Telephone Number	:	304-235-2500
Fax Number	:	304-235-0538

Authorized Official
Title or Position	:	PHYSICIAN PRACTICE MANAGER
Name	:	MRS. SANDRA RUNYON
Credential	:
Telephone Number	:	304-235-2500

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	11/09/2018

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1215007968 — JHANSI LANKA MD
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25661-3215

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1962540773 — WILLIAMSON MEMORIAL HOSPITAL LLC
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859 ALDERSON ST
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25661-3215

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Practice Location Address:

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Directions to “WILLIAMSON MEMORIAL HOSPITAL LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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