Provider Demographics
NPI:1922004530
Name:CHESAPEAKE HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:CHESAPEAKE HOSPITAL CORPORATION
Other - Org Name:RAPPAHANNOCK GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR PAYOR ADMINISTRATIO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-627-5573
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:101 HARRIS RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3880
Practice Address - Country:US
Practice Address - Phone:804-435-8000
Practice Address - Fax:804-435-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1885251E00000X
273R00000X, 291U00000X
VAH 1885282N00000X
VA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251E00000XAgenciesHome Health
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-01231Medicaid
VA=========OtherFED TAX ID/IRS
VA49-U123Medicare Oscar/Certification
VA497039Medicare Oscar/Certification
VA49-S123Medicare Oscar/Certification