Provider Demographics
NPI:1275620809
Name:HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:HJ THOMAS MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:DEONNA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-766-3536
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-766-3536
Mailing Address - Fax:304-766-4315
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-766-3536
Practice Address - Fax:304-766-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001391001Medicaid
WV0001391002Medicaid
WV0001391002Medicaid