Provider Demographics
NPI:1053848069
Name:SHENANDOAH MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:SHENANDOAH MEMORIAL HOSPITAL INC.
Other - Org Name:VALLEY HEALTH SHENANDOAH MEMORIAL HOSPITAL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, INSURANCE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-0231
Mailing Address - Street 1:759 S MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1154
Mailing Address - Country:US
Mailing Address - Phone:540-459-1325
Mailing Address - Fax:540-459-1326
Practice Address - Street 1:759 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1154
Practice Address - Country:US
Practice Address - Phone:540-459-1325
Practice Address - Fax:540-459-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty