Provider Demographics
NPI:1124192109
Name:WILLIAMSBURG REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:WILLIAMSBURG REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERNETHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-355-0151
Mailing Address - Street 1:500 NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4027
Mailing Address - Country:US
Mailing Address - Phone:843-355-0303
Mailing Address - Fax:843-355-0116
Practice Address - Street 1:500 NELSON BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4027
Practice Address - Country:US
Practice Address - Phone:843-355-8888
Practice Address - Fax:843-355-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42Z303Medicare PIN
SC421303Medicare ID - Type Unspecified