Provider Demographics
NPI:1710039664
Name:PCH OPERATIONS, LLC DBA R.J. REYNOLDS-PATRICK COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PCH OPERATIONS, LLC DBA R.J. REYNOLDS-PATRICK COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-8678
Mailing Address - Street 1:18688 JEB STUART HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1559
Mailing Address - Country:US
Mailing Address - Phone:276-694-3151
Mailing Address - Fax:276-694-8655
Practice Address - Street 1:18688 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1559
Practice Address - Country:US
Practice Address - Phone:276-694-3151
Practice Address - Fax:276-694-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146602OtherANTHEM
VA330049OtherMAMSI
VA146602OtherANTHEM
VA146602OtherANTHEM