| Kanawha Medical Center Inc | |
|
4924 Maccorkle Avenue Se Charleston WV 25304 | |
| (304) 925-1050 | |
| (304) 553-0862 |
| Full Name | Kanawha Medical Center Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4924 Maccorkle Avenue Se, Charleston, West Virginia |
| Authorized Official Name and Position | Thopsie V. Jagannath (OWNER) |
| Authorized Official Contact | 3049251050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kanawha Medical Center Inc 4924 Maccorkle Avenue Se Charleston WV 25304 Ph: (304) 925-1050 | Kanawha Medical Center Inc 4924 Maccorkle Avenue Se Charleston WV 25304 Ph: (304) 925-1050 |
| NPI Number | 1942247531 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 09/05/2023 |
| Medicare PECOS PAC ID | 0042242489 |
|---|---|
| Medicare Enrollment ID | O20050907000053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942247531 | NPI | - | NPPES |
| 3810003360 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Thopsie V Jagannath |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043257629 PECOS PAC ID: 6103858543 Enrollment ID: I20050912000705 |
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