Provider Demographics
NPI:1285798629
Name:COMMONWEALTH OF VIRGINIA PIEDMONT GERIATRIC HOSPITAL
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA PIEDMONT GERIATRIC HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:INGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-767-4405
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:BURKEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23922-0427
Mailing Address - Country:US
Mailing Address - Phone:434-767-4405
Mailing Address - Fax:434-767-4578
Practice Address - Street 1:5001 E. PATRICK HENRY HIGHWAY
Practice Address - Street 2:
Practice Address - City:BURKEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23922
Practice Address - Country:US
Practice Address - Phone:434-767-4405
Practice Address - Fax:434-767-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03189Medicare PIN