Basic Information
| Provider Information | |||||||||
| NPI: | 1629027263 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WINCHESTER MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINCHESTER MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365100 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405368000 | ||||||||
| FaxNumber: | 5405367681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHAMBERS | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MGR INS CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5405360231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WINCHESTER MEDICAL CENTER | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | H 1916 | VA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 092338900 | 05 | FL | MEDICAID | 0001738000 | 05 | WV | MEDICAID | 531929 | 01 | VA | NCPPO | OTHER | 004900057 | 01 | VA | SLH | OTHER | 005055500 | 05 | MD | MEDICAID | 0059412 | 01 | VA | UNITED MINE WORKERS-IP | OTHER | 004900057 | 05 | VA | MEDICAID | 2121886 | 01 | VA | OPTIMUM CHOICE, MDIPA | OTHER | 148653500 | 01 | VA | US DEPARTMENT OF LABOR | OTHER | 2121886 | 01 | VA | MAMSI,MAPSI,ALLIANCE | OTHER | 000039 | 01 | VA | ANTHEM | OTHER | 0059420 | 01 | VA | UNITED MINE WORKERS -OP | OTHER |