Provider Demographics
NPI: | 1760433791 |
---|---|
Name: | WINCHESTER MEDICAL CENTER, INC. |
Entity Type: | Organization |
Organization Name: | WINCHESTER MEDICAL CENTER, INC. |
Other - Org Name: | |
Other - Org Type: | |
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: | 1840 AMHERST ST |
Mailing Address - Street 2: | |
Mailing Address - City: | WINCHESTER |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22601-2808 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-536-8000 |
Mailing Address - Fax: | 540-536-7681 |
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,INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-05-15 |
Last Update Date: | 2023-07-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | H1916 | 101YP2500X, 1041C0700X, 207RC0000X, 282N00000X |
VA | H 1916 | 133V00000X, 207P00000X, 207V00000X, 207VM0101X, 363A00000X, 363LP0808X, 367500000X |
2084N0400X, 261QM0801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | 0001738002 | Medicaid | |
VA | 004900057 | Medicaid | |
MD | 005055500 | Medicaid | |
VA | 004900057 | Medicaid | |
VA | =========-003 | Other | TRICARE |
MD | 005055500 | Medicaid | |
VA | 004900057 | Medicaid | |
VA | ========= | Other | VARIOUS INSURANCES |