Basic Information
| Provider Information | |||||||||
| NPI: | 1710494331 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANDOAH MEMORIAL HOSPITAL, INC. | ||||||||
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| OtherOrganizationName: | VALLEY HEALTH SHENANDOAH MEMORIAL HOSPITAL FAMILY MEDICINE STRASBURG | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405360231 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 33674 OLD VALLEY PIKE | ||||||||
| Address2: | |||||||||
| City: | STRASBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226573704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404653751 | ||||||||
| FaxNumber: | 5404655008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2018 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
| AuthorizedOfficialMiddleName: | NEVADA | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5405360103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 207Q00000X | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.