Provider Demographics
NPI:1891017141
Name:MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.
Other - Org Name:MARY WASHINGTON HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1414
Mailing Address - Street 1:2300 FALL HILL AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3343
Mailing Address - Country:US
Mailing Address - Phone:540-741-1667
Mailing Address - Fax:540-741-3581
Practice Address - Street 1:2300 FALL HILL AVE STE 401
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3343
Practice Address - Country:US
Practice Address - Phone:540-741-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHSP-1044251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHG8OtherCARE FIRST/BC/BS
VA1891017141Medicaid
VA337457OtherBC/BS RICHMOND/ROANOKE
VA491518Medicare Oscar/Certification