NPIMap

Organization Active NPI

Stonewall Jackson Memorial Hospital

Doing business as Lively Healthcare Center

  • Family Medicine Physician
  • Jane Lew, WV
National Provider Identifier
1225299605
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19972 Issued in WV
Legal business name
STONEWALL JACKSON MEMORIAL HOSPITAL
Doing business as
Lively Healthcare Center
Practice address
533 Hackers Creek Rd
Jane Lew, WV 26378-8394
Phone
(304) 884-8941
Fax
(304) 884-8943
NPI assigned
Jun 19, 2008
Last updated
Jun 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David D Shaffer
Title
Ceo
Phone
(304) 269-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19972 WV Primary

Addresses

Primary practice location

533 Hackers Creek Rd
Jane Lew, WV 26378-8394

Mailing address

230 Hospital PLZ
Weston, WV 26452-8558
Phone (304) 269-8000

Other identifiers 1

IdentifierTypeStateIssuer
0001417002MedicaidWV

Other names 1

  • Lively Healthcare Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Stonewall Jackson Memorial6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

533 Hackers Creek Rd
Jane Lew, WV 26378
Phone (304) 884-8941

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1225299605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 HOSPITAL PLZ",
            "city": "WESTON",
            "state": "WV",
            "postal_code": "264528558",
            "telephone_number": "304-269-8000",
            "fax_number": "304-269-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 HACKERS CREEK RD",
            "city": "JANE LEW",
            "state": "WV",
            "postal_code": "263788394",
            "telephone_number": "304-884-8941",
            "fax_number": "304-884-8943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEWALL JACKSON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-269-8000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "19972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001417002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lively Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jane Lew, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.