Provider Demographics
NPI:1376781294
Name:WARREN MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:WARREN MEMORIAL HOSPITAL, INC.
Other - Org Name:WARREN MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-636-0300
Mailing Address - Street 1:1000 N SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3547
Mailing Address - Country:US
Mailing Address - Phone:540-636-0300
Mailing Address - Fax:540-636-0198
Practice Address - Street 1:120 N COMMERCE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4417
Practice Address - Country:US
Practice Address - Phone:540-636-0300
Practice Address - Fax:540-636-0198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARREN MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1913261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy