Provider Demographics
NPI:1013199322
Name:PAGE MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:PAGE MEMORIAL HOSPITAL, INC.
Other - Org Name:VALLEY HEALTH PAGE MEMORIAL HOSPITAL FAMILY MEDICINE- SHENANDOAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CORRDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBBAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-1867
Mailing Address - Street 1:505 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:VA
Mailing Address - Zip Code:22849-1263
Mailing Address - Country:US
Mailing Address - Phone:540-652-9100
Mailing Address - Fax:540-652-9119
Practice Address - Street 1:505 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:VA
Practice Address - Zip Code:22849-1263
Practice Address - Country:US
Practice Address - Phone:540-652-9100
Practice Address - Fax:540-652-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192126OtherANTHEM
VA010275709Medicaid
VA192126OtherANTHEM
VA010275709Medicaid