Provider Demographics
NPI:1033166442
Name:SHENANDOAH MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:SHENANDOAH MEMORIAL HOSPITAL, INC.
Other - Org Name:SHENANDOAH MEMORIAL HOSPITAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-459-1221
Mailing Address - Street 1:759 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1127
Mailing Address - Country:US
Mailing Address - Phone:540-459-1120
Mailing Address - Fax:540-459-1121
Practice Address - Street 1:759 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1127
Practice Address - Country:US
Practice Address - Phone:540-459-1120
Practice Address - Fax:540-459-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1900282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-00065Medicaid
VA49-1305Medicare PIN
VA49-Z305Medicare Oscar/Certification
VA49-00065Medicaid
VA49-Z305Medicare PIN