MEDICARE: MARTHA JEFFERSON HOSPITAL

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326764572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA JEFFERSON HOSPITAL

Provider Business Mailing Address
First Line	:	500 MARTHA JEFFERSON DR
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-4668
Country	:	US
Telephone Number	:	434-654-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 HEALTH CAMPUS DR STE 120
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8809
Country	:	US
Telephone Number	:	540-689-4700
Fax Number	:	540-689-4701

Authorized Official
Title or Position	:	DIR, FINANCE
Name	:	DEBORAH THEXTON
Credential	:
Telephone Number	:	434-654-8199

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	11/15/2022

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