Provider Demographics
NPI:1437250396
Name:PAGE MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:PAGE MEMORIAL HOSPITAL, INC.
Other - Org Name:PAGE SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-743-4561
Mailing Address - Street 1:250 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835
Mailing Address - Country:US
Mailing Address - Phone:540-743-3541
Mailing Address - Fax:540-743-9560
Practice Address - Street 1:250 MEMORIAL DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835
Practice Address - Country:US
Practice Address - Phone:540-743-3541
Practice Address - Fax:540-743-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05313Medicare PIN
VAC00231Medicare ID - Type UnspecifiedGROUP#