Provider Demographics
NPI:1578568655
Name:SIMANIS, JURIS (MD)
Entity Type:Individual
Prefix:
First Name:JURIS
Middle Name:
Last Name:SIMANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:JACKSON RIVER INTERNIST
Practice Address - Street 2:1 ARH LANE, STE. 300
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-6710
Practice Address - Fax:540-862-5727
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV54183971800OtherWV WORKERS COMPENSATION
58030OtherSOUTHERN HEALTH
58030OtherCARELINK
5258798OtherCCN
VA541839718027OtherBS MOUNTAIN STATE
5357280OtherAETNA
VA282211OtherANTHEM
541839718OtherC&O
VA006099467Medicaid
200026OtherLUNG
6610094OtherCIGNA
200026OtherLUNG
6610094OtherCIGNA
1519679Medicare ID - Type UnspecifiedUMWA
1200890010Medicare ID - Type UnspecifiedADMINSTAR FEDERAL
110137213Medicare ID - Type UnspecifiedRAILROAD MEDICARE/RRMC