Provider Demographics
NPI:1396827036
Name:PRINCE WILLIAM HOSPITAL
Entity Type:Organization
Organization Name:PRINCE WILLIAM HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-369-8021
Mailing Address - Street 1:8609 SUDLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8321
Mailing Address - Country:US
Mailing Address - Phone:703-369-8448
Mailing Address - Fax:703-369-8667
Practice Address - Street 1:8609 SUDLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8321
Practice Address - Country:US
Practice Address - Phone:703-369-8448
Practice Address - Fax:703-369-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4974123Medicaid
497412Medicare ID - Type Unspecified