Provider Demographics
NPI:1992748255
Name:MARY WASHINGTON HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:MARY WASHINGTON HEALTHCARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1494
Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-741-1425
Mailing Address - Fax:540-371-1968
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-741-1425
Practice Address - Fax:540-371-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
VA02010020703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8514372Medicaid
2103986OtherPK
2103986OtherPK