Provider Demographics
NPI:1831644897
Name:BEDFORD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEDFORD MEMORIAL HOSPITAL
Other - Org Name:BEDFORD ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JURKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-425-7601
Mailing Address - Street 1:1617 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1213
Mailing Address - Country:US
Mailing Address - Phone:540-586-8424
Mailing Address - Fax:
Practice Address - Street 1:1617 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1213
Practice Address - Country:US
Practice Address - Phone:540-586-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAADC994441343900000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0049483438Medicaid
VA0087303423Medicaid