Provider Demographics
NPI:1629027263
Name:WINCHESTER MEDICAL CENTER
Entity Type:Organization
Organization Name:WINCHESTER MEDICAL CENTER
Other - Org Name:WINCHESTER MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MGR INS CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-0231
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:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1916273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL092338900Medicaid
WV0001738000Medicaid
VA531929OtherNCPPO
VA004900057OtherSLH
MD005055500Medicaid
VA0059412OtherUNITED MINE WORKERS-IP
VA004900057Medicaid
VA2121886OtherOPTIMUM CHOICE, MDIPA
VA148653500OtherUS DEPARTMENT OF LABOR
VA2121886OtherMAMSI,MAPSI,ALLIANCE
VA000039OtherANTHEM
VA0059420OtherUNITED MINE WORKERS -OP
VA=========-009OtherTRICARE
FL092338900Medicaid
VA2121886OtherOPTIMUM CHOICE, MDIPA