1962453936 NPI number — WINCHESTER MEDICAL CENTER

Table of content: (NPI 1962453936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962453936 NPI number — WINCHESTER MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINCHESTER 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:
WINCHESTER REHABILITATION 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:
1962453936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 CAMPUS BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5100
Provider Business Mailing Address Fax Number:
540-536-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W CORK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-3870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-536-5114
Provider Business Practice Location Address Fax Number:
540-536-5139
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMOS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
540-536-2607

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  H1914 , 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: 000039 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005055500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2121886 . This is a "OPTIMUM CHOICE, MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0059412 . This is a "UNITED MINE WORKERS - IP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 148653500 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 092338900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531913 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2121886 . This is a "MAMSI, MAPSI, ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0059420 . This is a "UNITED MINE WORKERS - OP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004930339 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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