Provider Demographics
NPI:1124005061
Name:ST JOSEPHS HOSPITAL OF BUCKHANNON INC
Entity Type:Organization
Organization Name:ST JOSEPHS HOSPITAL OF BUCKHANNON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON-PHILLIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:304-473-2118
Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-473-2000
Mailing Address - Fax:304-473-2180
Practice Address - Street 1:1 AMALIA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2239
Practice Address - Country:US
Practice Address - Phone:304-473-2000
Practice Address - Fax:304-473-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X, 332B00000X
WV87282NR1301X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001139000Medicaid
510053OtherFORMER CCN
511321Medicare Oscar/Certification
WV510053Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WV4703820001Medicare NSC