Provider Demographics
NPI:1568852614
Name:UVA PRINCE WILLIAM MEDICAL CENTER
Entity Type:Organization
Organization Name:UVA PRINCE WILLIAM MEDICAL CENTER
Other - Org Name:UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CODER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-835-2069
Mailing Address - Street 1:PO BOX 800750
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0750
Mailing Address - Country:US
Mailing Address - Phone:434-924-8344
Mailing Address - Fax:
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4418
Practice Address - Country:US
Practice Address - Phone:703-369-8000
Practice Address - Fax:703-369-8032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UVA PRINCE WILLIAM MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-28
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1882174400000X
VAH1882282N00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4900456Medicaid
VA4900456Medicaid
VA490045Medicare UPIN