Provider Demographics
NPI:1942247531
Name:KANAWHA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:KANAWHA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOPSIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:JAGANNATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-925-1050
Mailing Address - Street 1:4924 MACCORKLE AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-925-1050
Mailing Address - Fax:304-553-0862
Practice Address - Street 1:4924 MACCORKLE AVENUE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-925-1050
Practice Address - Fax:304-553-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003360Medicaid
WV3810003360Medicaid