Provider Demographics
NPI:1598779571
Name:PAGE MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:PAGE MEMORIAL HOSPITAL INC.
Other - Org Name:VALLEY HEALTH PAGE MEMORIAL HOSPITAL FAMILY MEDICINE- STANLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:NEVADA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-0103
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:VA
Practice Address - Zip Code:22851-4112
Practice Address - Country:US
Practice Address - Phone:540-778-1249
Practice Address - Fax:540-743-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610181Medicaid
VA007610181Medicaid