MEDICARE: KANAWHA MEDICAL CENTER INC

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	207R00000X	Internal Medicine Physician

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

General Provider Information

NPI Number	:	1942247531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANAWHA MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	4924 MACCORKLE AVENUE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304
Country	:	US
Telephone Number	:	304-925-1050
Fax Number	:	304-553-0862

Provider Business Practice Location Address
First Line	:	4924 MACCORKLE AVENUE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304
Country	:	US
Telephone Number	:	304-925-1050
Fax Number	:	304-553-0862

Authorized Official
Title or Position	:	OWNER
Name	:	THOPSIE V. JAGANNATH
Credential	:	MD
Telephone Number	:	304-925-1050

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	09/05/2023

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