Provider Demographics
NPI:1619938149
Name:SENTARA HOSPITALS
Entity Type:Organization
Organization Name:SENTARA HOSPITALS
Other - Org Name:SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO. SH
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-7020
Mailing Address - Street 1:6015 POPLAR HALL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3819
Mailing Address - Country:US
Mailing Address - Phone:757-455-7102
Mailing Address - Fax:757-455-7919
Practice Address - Street 1:100 SENTARA CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1898282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-0066-9OtherCHARTERED MEDICAID
VA082033OtherCOUNSEL SERVICES
VA540634958OtherOTHERS
VA0049000669OtherSTATE & LOCAL HOSPITAL
VA330477OtherTRIGON PROF
VA49-0066-9Medicaid
VA540634958OtherTRICARE
VA000077OtherTRIGON
VA000077OtherHEALTHKEEPERS
VAWHOtherSHM ENTITY
VA49-0066-9Medicaid
VAWHOtherSHM ENTITY