Provider Demographics
NPI:1538691449
Name:WILLIAMSBURG REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:WILLIAMSBURG REGIONAL HOSPITAL
Other - Org Name:WILLIAMSBURG FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIANS PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-355-8888
Mailing Address - Street 1:500 NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4027
Mailing Address - Country:US
Mailing Address - Phone:843-355-8888
Mailing Address - Fax:843-355-0123
Practice Address - Street 1:500 THURGOOD MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4143
Practice Address - Country:US
Practice Address - Phone:843-355-8888
Practice Address - Fax:843-355-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment