Provider Demographics
NPI:1528212123
Name:PATRICK HOSPITAL, LLC
Entity Type:Organization
Organization Name:PATRICK HOSPITAL, LLC
Other - Org Name:RADIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-8678
Mailing Address - Street 1:18688 JEB STUART HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1559
Mailing Address - Country:US
Mailing Address - Phone:276-694-8678
Mailing Address - Fax:276-694-8655
Practice Address - Street 1:18688 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1559
Practice Address - Country:US
Practice Address - Phone:276-694-8655
Practice Address - Fax:276-694-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID NUMBER