Provider Demographics
NPI:1295728491
Name:BEDFORD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BEDFORD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROFESSIONAL BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5715
Mailing Address - Street 1:PO BOX 13966
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24038-3966
Mailing Address - Country:US
Mailing Address - Phone:540-586-2441
Mailing Address - Fax:
Practice Address - Street 1:1613 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:540-586-2441
Practice Address - Fax:540-224-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1828282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007656OtherANTHEM
VA146322OtherSOUTHERN HEALTH
VA169543000OtherWEST VIRGINIA MEDICAID
VA0000844OtherSLH
VA354365000OtherMAGELLAN
VA4900880Medicaid
VA030589500OtherBLACK LUNG
VA007656OtherANTHEM
VA4900880Medicaid