1225143498 NPI number — PATRICK HENRY HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225143498 NPI number — PATRICK HENRY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK HENRY HOSPITAL, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1225143498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 DENBIGH BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23608-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-875-2023
Provider Business Mailing Address Fax Number:
757-875-2016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
672 GLOUCESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALUDA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-758-2363
Provider Business Practice Location Address Fax Number:
804-758-3857
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
757-875-7846

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 49E185 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X , with the licence number: 49E185 , 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: 004966767 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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