1417005760 NPI number — UVA PRINCE WILLIAM MEDICAL CENTER

Table of content: (NPI 1417005760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417005760 NPI number — UVA PRINCE WILLIAM MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UVA PRINCE WILLIAM MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417005760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800750
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22908-0750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-924-8344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 SUDLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-369-8000
Provider Business Practice Location Address Fax Number:
703-369-8032
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CODER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
804-835-2069

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H1882 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4900456 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009476400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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