Provider Demographics
NPI:1962453936
Name:WINCHESTER MEDICAL CENTER
Entity Type:Organization
Organization Name:WINCHESTER MEDICAL CENTER
Other - Org Name:WINCHESTER REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-2607
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5114
Practice Address - Fax:540-536-5139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1914273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000039OtherANTHEM
MD005055500Medicaid
VA2121886OtherOPTIMUM CHOICE, MDIPA
VA0059412OtherUNITED MINE WORKERS - IP
VA148653500OtherUS DEPARTMENT OF LABOR
FL092338900Medicaid
VA531913OtherNCPPO
VA2121886OtherMAMSI, MAPSI, ALLIANCE
VA0059420OtherUNITED MINE WORKERS - OP
VA004930339Medicaid
VA004930339Medicaid
VA=========OtherMISCELLANEOUS INSURANCES
VA49T005Medicare Oscar/Certification