Provider Demographics
NPI:1497935365
Name:COMMONWEALTH HOSP SVCS
Entity Type:Organization
Organization Name:COMMONWEALTH HOSP SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SPRING
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-521-5315
Mailing Address - Street 1:4050 INNSLAKE DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3327
Mailing Address - Country:US
Mailing Address - Phone:804-521-5315
Mailing Address - Fax:804-521-5312
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5205
Practice Address - Country:US
Practice Address - Phone:804-289-4951
Practice Address - Fax:804-289-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA302011OtherANTHEM
VA1497935365Medicaid
VA619583OtherSOUTHERN HEALTH
VADN0296OtherMEDICARE RAILROAD
VAC10296Medicare PIN