Provider Demographics
NPI:1104083385
Name:WINCHESTER MEDICAL CENTER
Entity type:Organization
Organization Name:WINCHESTER MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BAMBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-5122
Mailing Address - Street 1:333 W CORK ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3870
Mailing Address - Country:US
Mailing Address - Phone:540-536-5122
Mailing Address - Fax:540-536-5340
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:SUITE 145
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5122
Practice Address - Fax:540-536-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104083385Medicaid
VA1104083385Medicaid
VA1104083385Medicaid