Provider Demographics
NPI:1245327873
Name:HERBERT J THOMAS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HERBERT J THOMAS MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUTNS
Authorized Official - Prefix:
Authorized Official - First Name:DEONNA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-766-3536
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-766-3536
Mailing Address - Fax:304-766-4315
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-766-3536
Practice Address - Fax:304-766-4315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001391003Medicaid
WV0001391003Medicaid