Provider Demographics
NPI:1922392851
Name:STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY
Entity Type:Organization
Organization Name:STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY
Other - Org Name:WESTON ORTHOPEDIC AND SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-269-8080
Mailing Address - Street 1:29 HOSPITAL PLZ STE C
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8471
Mailing Address - Country:US
Mailing Address - Phone:304-269-4431
Mailing Address - Fax:304-269-9803
Practice Address - Street 1:29 HOSPITAL PLZ STE C
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8471
Practice Address - Country:US
Practice Address - Phone:304-269-4431
Practice Address - Fax:304-269-9803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty