Provider Demographics
NPI:1790028744
Name:HERBERT J. THOMAS MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:HERBERT J. THOMAS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR OF BHS
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:304-766-3441
Mailing Address - Street 1:4825 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1365
Mailing Address - Country:US
Mailing Address - Phone:304-766-4560
Mailing Address - Fax:304-766-4599
Practice Address - Street 1:4825 MACCORKLE AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1365
Practice Address - Country:US
Practice Address - Phone:304-766-4560
Practice Address - Fax:304-766-4599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV109261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV50090Medicaid
WV0001391000Medicaid
WV0001391000Medicaid