Provider Demographics
NPI:1649503418
Name:ST JOSEPHS HOSPITAL OF BUCKHANNON
Entity type:Organization
Organization Name:ST JOSEPHS HOSPITAL OF BUCKHANNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON-PHILLIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:304-473-2118
Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-473-2000
Mailing Address - Fax:304-473-2180
Practice Address - Street 1:1 1 AMALIA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2239
Practice Address - Country:US
Practice Address - Phone:304-473-2000
Practice Address - Fax:304-473-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X, 282NR1301X, 275N00000X
WV87282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
51U053OtherFORMER CCN
51U053OtherFORMER CCN
51Z321Medicare Oscar/Certification