Provider Demographics
NPI:1053814129
Name:WINCHESTER MEDICAL CENTER
Entity Type:Organization
Organization Name:WINCHESTER MEDICAL CENTER
Other - Org Name:VALLEY HEALTH PULMONARY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHRENHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-655-2656
Mailing Address - Street 1:PO BOX 7402
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116-7402
Mailing Address - Country:US
Mailing Address - Phone:800-655-2656
Mailing Address - Fax:412-822-7411
Practice Address - Street 1:190 CAMPUS BLVD STE 410
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-536-5980
Practice Address - Fax:412-822-7411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-14
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty