1548366404 NPI number — POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM

Table of content: (NPI 1548366404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548366404 NPI number — POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM
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:
SENTARA NORTHERN VIRGINIA 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:
1548366404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 OPITZ BLVD
Provider Second Line Business Mailing Address:
PATIENT FINANCIAL SERVICES
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22191-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-670-1595
Provider Business Mailing Address Fax Number:
703-670-3267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 OPITZ BLVD
Provider Second Line Business Practice Location Address:
PATIENT FINANCIAL SERVICES
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22191-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-670-1595
Provider Business Practice Location Address Fax Number:
703-670-3267
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROERMANN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SVP/CFO
Authorized Official Telephone Number:
757-455-7020

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H1771 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000028 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 293165 . This is a "ANTHEM HCFA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4901134 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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