Provider Demographics
NPI:1952649360
Name:THOMAS JOHNS CANCER HOSPITAL AT JOHNSTON WILLIS HOSPITAL
Entity Type:Organization
Organization Name:THOMAS JOHNS CANCER HOSPITAL AT JOHNSTON WILLIS HOSPITAL
Other - Org Name:CJW MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ONCOLOGY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIGON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-267-6074
Mailing Address - Street 1:1401 JOHNSTON WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-330-2323
Mailing Address - Fax:804-267-6130
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-330-2323
Practice Address - Fax:804-267-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001159082284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital