Provider Demographics
NPI:1427597830
Name:WINCHESTER MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WINCHESTER MEDICAL CENTER, INC.
Other - Org Name:UROLOGY CLINIC OF WMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHILIPS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:540-536-8021
Mailing Address - Street 1:PO BOX 37152
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3152
Mailing Address - Country:US
Mailing Address - Phone:540-536-7670
Mailing Address - Fax:540-536-7682
Practice Address - Street 1:1712 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2807
Practice Address - Country:US
Practice Address - Phone:540-667-1712
Practice Address - Fax:540-665-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty