Provider Demographics
NPI:1477571206
Name:MARTHA JEFFERSON HOSPITAL
Entity Type:Organization
Organization Name:MARTHA JEFFERSON HOSPITAL
Other - Org Name:HEART RHYTHM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-654-7305
Mailing Address - Street 1:500 MARTHA JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4668
Mailing Address - Country:US
Mailing Address - Phone:434-654-7000
Mailing Address - Fax:
Practice Address - Street 1:500 MARTHA JEFFERSON DRIVE
Practice Address - Street 2:MB# G231
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4668
Practice Address - Country:US
Practice Address - Phone:434-654-7195
Practice Address - Fax:434-654-4794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHA JEFFERSON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACB4590Medicare PIN
VAC00221Medicare PIN