Provider Demographics
NPI:1437191814
Name:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Other - Org Name:PHYSICIANS CARE OF ST JOSEPHS
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:304-424-4057
Mailing Address - Street 1:600 18TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101
Mailing Address - Country:US
Mailing Address - Phone:304-424-4135
Mailing Address - Fax:304-424-4137
Practice Address - Street 1:600 18TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3231
Practice Address - Country:US
Practice Address - Phone:304-424-4135
Practice Address - Fax:304-424-4137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
WV21425 HEATHER IRVIN207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0240091000Medicaid
WVCO9331312Medicare ID - Type Unspecified