Provider Demographics
NPI:1225637242
Name:HASTINGS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HASTINGS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHOMO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:540-746-8278
Mailing Address - Street 1:1164 SHARPES DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-1508
Mailing Address - Country:US
Mailing Address - Phone:540-746-8278
Mailing Address - Fax:
Practice Address - Street 1:HASTINGS MEDICAL CLINIC OF BRIDGEWATER
Practice Address - Street 2:110 NORTH MAIN STREET SUITE A
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812
Practice Address - Country:US
Practice Address - Phone:540-746-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty