Provider Demographics
NPI:1508974940
Name:PEDIATRIC ASSOCIATES OF WINCHESTER
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF WINCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR/ACCTS RECEIVA
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-662-3853
Mailing Address - Street 1:1002 AMHERST ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3323
Mailing Address - Country:US
Mailing Address - Phone:540-662-3853
Mailing Address - Fax:540-662-0336
Practice Address - Street 1:1002 AMHERST ST
Practice Address - Street 2:BLDG C
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3323
Practice Address - Country:US
Practice Address - Phone:540-662-3853
Practice Address - Fax:540-662-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001745Medicaid