Provider Demographics
NPI:1649269770
Name:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-4057
Mailing Address - Street 1:1824 MURDOCH AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3230
Mailing Address - Country:US
Mailing Address - Phone:304-424-4760
Mailing Address - Fax:304-424-4761
Practice Address - Street 1:1824 MURDOCH AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3230
Practice Address - Country:US
Practice Address - Phone:304-424-4760
Practice Address - Fax:304-424-4761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA-ST JOSEPHS HEALTHCARE SYSTEM LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000284Medicaid
OH2497669Medicaid
WVCO9331313Medicare ID - Type UnspecifiedGROUP NUMBER