Basic Information
Provider Information | |||||||||
NPI: | 1295140283 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SENTARA RMH MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | RMH ORTHOPEDICS DME JMU | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1430 | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 228031430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405647036 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 724 SOUTH MASON STREET | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 22801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5406895500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/27/2014 | ||||||||
LastUpdateDate: | 06/27/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FOSTER | ||||||||
AuthorizedOfficialFirstName: | SUSAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS MEDICAL GRP | ||||||||
AuthorizedOfficialTelephone: | 5404334137 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | H1891 | VA | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.