Provider Demographics
NPI:1346205069
Name:COMMONWEALTH OF VIRGINIA WESTERN STATE HOSPITAL
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA WESTERN STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-332-8200
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:1301 RICHMOND RD.
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-2500
Mailing Address - Country:US
Mailing Address - Phone:540-332-8200
Mailing Address - Fax:540-332-8197
Practice Address - Street 1:1301 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9146
Practice Address - Country:US
Practice Address - Phone:540-332-8200
Practice Address - Fax:540-332-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064830Medicaid
VA0000000007816OtherANTHEM BLUE CROSS
VA004941063Medicaid
VA010064830Medicaid
VA490106Medicare ID - Type Unspecified
VAC02261Medicare ID - Type UnspecifiedPHYSICIAN