Provider Demographics
NPI:1528028396
Name:SENTARA PRINCESS ANNE HOSPITAL
Entity Type:Organization
Organization Name:SENTARA PRINCESS ANNE HOSPITAL
Other - Org Name:SENTARA HOSPITALS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-7020
Mailing Address - Street 1:6015 POPLAR HALL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3819
Mailing Address - Country:US
Mailing Address - Phone:757-455-7102
Mailing Address - Fax:757-455-7919
Practice Address - Street 1:2025 GLENN MITCHELL DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0178
Practice Address - Country:US
Practice Address - Phone:757-507-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0404X
VAH 1893282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010576OtherTRIGON
VA232300OtherMAMSI
VA541547408OtherOTHERS
VA49-0119-3OtherCHARTERED MEDICAID
VA49-0119-3Medicaid
VA541547408OtherTRICARE
VA6560685OtherAETNA
VA010576OtherHEALTHKEEPERS
VABSOtherSHM ENTITY
VA541547408OtherOTHERS
VA49-0119-3Medicaid