Provider Demographics
NPI:1174682785
Name:COLUMBIA- ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:COLUMBIA- ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Other - Org Name:LOMA PRIETA OB GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-4111
Mailing Address - Street 1:600 18TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3231
Mailing Address - Country:US
Mailing Address - Phone:304-424-4124
Mailing Address - Fax:304-424-4123
Practice Address - Street 1:600 18TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3231
Practice Address - Country:US
Practice Address - Phone:304-424-4124
Practice Address - Fax:304-424-4123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0240074000Medicaid
WV0240074000Medicaid