Provider Demographics
NPI:1609060425
Name:COLUMBIA ST. JOSEPH'S HEALTHCARE SYSTEMS LP
Entity Type:Organization
Organization Name:COLUMBIA ST. JOSEPH'S HEALTHCARE SYSTEMS LP
Other - Org Name:LOMA PRIETA OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-4124
Mailing Address - Street 1:600 18TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3231
Mailing Address - Country:US
Mailing Address - Phone:304-424-4124
Mailing Address - Fax:304-424-4124
Practice Address - Street 1:600 18TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3231
Practice Address - Country:US
Practice Address - Phone:304-424-4124
Practice Address - Fax:304-424-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0240074000Medicaid
DB5300OtherRR MEDICARE
WVCO9331311Medicare PIN