Provider Demographics
NPI:1841603776
Name:BEDFORD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEDFORD MEMORIAL HOSPITAL
Other - Org Name:BEDFORD HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-4708
Mailing Address - Street 1:1920 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1104
Mailing Address - Country:US
Mailing Address - Phone:434-200-1816
Mailing Address - Fax:434-200-6638
Practice Address - Street 1:1621 WHITFIELD DR
Practice Address - Street 2:SUITE C
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1519
Practice Address - Country:US
Practice Address - Phone:434-200-1816
Practice Address - Fax:434-200-6638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRA HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
EXEMPT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005OtherTRICARE
VA147124OtherSOUTHERN HEALTH
VA337476OtherANTHEM
VA004910435Medicaid
VA337476OtherANTHEM