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Stonewall Jackson Memorial Hospital

Organization Active NPI Obstetrics & Gynecology Physician · Weston, WV

NPI 1669633962 · NPPES record last updated Jun 26, 2008

Key facts

NPI
1669633962
Entity type
Organization (NPI type 2)
Primary specialty
Obstetrics & Gynecology Physician 207V00000X
License
20690 (WV)
Legal business name
STONEWALL JACKSON MEMORIAL HOSPITAL
Practice address
66 Hospital PLZ
Suite 103
Weston, WV 26452-8552
Phone
(304) 269-3108
Fax
(304) 269-3109
NPI assigned
Jun 19, 2008
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 5

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

National Provider Directory

Tax ID family
Stonewall Jackson Memorial Hospital (6 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207V00000X 20690 WV Yes

Addresses

Primary practice location

66 Hospital PLZ
Suite 103
Weston, WV 26452-8552

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
0001417002MedicaidWV

Other names

  • Mountaineer Healthcare for Women Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 26, 2008.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1669633962",
    "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": "66 HOSPITAL PLZ",
            "address_2": "SUITE 103",
            "city": "WESTON",
            "state": "WV",
            "postal_code": "264528552",
            "telephone_number": "304-269-3108",
            "fax_number": "304-269-3109"
        }
    ],
    "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": "ADMINISTRATOR",
        "authorized_official_telephone_number": "304-269-8000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "WV",
            "license": "20690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001417002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountaineer Healthcare for Women",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Weston, WV

All providers in Weston, WV · Obstetrics & Gynecology Physician in West Virginia

Sources for this page

Verify at the official NPI Registry.