Provider Demographics
NPI:1053842468
Name:SHENANDOAH MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:SHENANDOAH MEMORIAL HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER, INSURANCE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-0231
Mailing Address - Street 1:5173 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-9513
Mailing Address - Country:US
Mailing Address - Phone:540-459-1350
Mailing Address - Fax:540-459-1351
Practice Address - Street 1:5173 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-9513
Practice Address - Country:US
Practice Address - Phone:540-459-1350
Practice Address - Fax:540-459-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty