Provider Demographics
NPI:1477979102
Name:JEFFERSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JEFFERSON MEMORIAL HOSPITAL
Other - Org Name:JEFFERSON PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-264-1358
Mailing Address - Street 1:2000 FOUNDATION WAY
Mailing Address - Street 2:SUITE 2310
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9003
Mailing Address - Country:US
Mailing Address - Phone:304-264-1358
Mailing Address - Fax:304-260-1480
Practice Address - Street 1:912 SOMERSET BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25401-3952
Practice Address - Country:US
Practice Address - Phone:304-728-1601
Practice Address - Fax:304-725-3690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST VIRGINIA UNIVERSITY HOSPITALS EAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-05
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy