Provider Demographics
NPI:1508856469
Name:COLUMBIA-ST. JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:COLUMBIA-ST. JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Other - Org Name:INPATIENT SPECIALISTS OF ST JOSEPH'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-4506
Mailing Address - Street 1:1824 MURDOCH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3230
Mailing Address - Country:US
Mailing Address - Phone:304-424-4062
Mailing Address - Fax:304-424-4061
Practice Address - Street 1:1824 MURDOCH AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3230
Practice Address - Country:US
Practice Address - Phone:304-424-4062
Practice Address - Fax:304-424-4061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001078005Medicaid
WV0001078005Medicaid