Provider Demographics
NPI:1831274430
Name:JEFFERSON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:JEFFERSON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ECKENFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-1107
Mailing Address - Street 1:1400 US HIGHWAY 61
Mailing Address - Street 2:SUITE G - 50
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-933-1670
Mailing Address - Fax:636-933-1203
Practice Address - Street 1:1400 US HIGHWAY 61
Practice Address - Street 2:SUITE G - 50
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-933-1670
Practice Address - Fax:636-933-1203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL JEFFERSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty