Provider Demographics
NPI:1770576118
Name:BEDFORD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BEDFORD MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JURKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-587-3385
Mailing Address - Street 1:1621 WHITFIELD DR STE C
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1519
Mailing Address - Country:US
Mailing Address - Phone:540-224-4753
Mailing Address - Fax:
Practice Address - Street 1:1621 WHITFIELD DR STE C
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
EXEMPT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA337476OtherANTHEM
VA004910435Medicaid
VA147124OtherSOUTHERN HEALTH
VA147124OtherSOUTHERN HEALTH
VA147124OtherSOUTHERN HEALTH