Provider Demographics
NPI:1316364953
Name:JEFFERSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JEFFERSON MEMORIAL HOSPITAL
Other - Org Name:JMC EKG PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZELENKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-264-1000
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1170
Mailing Address - Country:US
Mailing Address - Phone:304-264-1358
Mailing Address - Fax:304-260-1430
Practice Address - Street 1:300 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1631
Practice Address - Country:US
Practice Address - Phone:304-728-1669
Practice Address - Fax:304-725-9492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST VIRGINIA UNIVERSITY HOSPITALS - EAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-20
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty