Provider Demographics
NPI:1912227158
Name:WEST JEFFERSON INTERNAL MEDICINE
Entity type:Organization
Organization Name:WEST JEFFERSON INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:614-879-7300
Mailing Address - Street 1:95 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162
Mailing Address - Country:US
Mailing Address - Phone:614-879-7300
Mailing Address - Fax:614-879-7151
Practice Address - Street 1:95 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162
Practice Address - Country:US
Practice Address - Phone:614-879-7300
Practice Address - Fax:614-879-7151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST JEFFERSON INTERNAL MEDICINE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-10
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP057914363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty