Provider Demographics
NPI:1538142005
Name:WINCHESTER MEDICAL CENTER
Entity Type:Organization
Organization Name:WINCHESTER MEDICAL CENTER
Other - Org Name:WINCHESTER MEDICAL CENTER HOME HEALTH AGENCY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROYSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-5200
Mailing Address - Street 1:333 WEST CORK ST
Mailing Address - Street 2:STE 135
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3870
Mailing Address - Country:US
Mailing Address - Phone:540-536-5200
Mailing Address - Fax:540-536-5202
Practice Address - Street 1:333 WEST CORK ST
Practice Address - Street 2:STE 135
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5200
Practice Address - Fax:540-536-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497058251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4970586Medicaid
VA100431OtherBCBS PROVIDER NUMBER
VA4970586Medicaid
VA4970586Medicaid