Basic Information
| Provider Information | |||||||||
| NPI: | 1578754123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINCHESTER MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | ARRHYTHMIA SERVICES OF WINCHESTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 AMHERST ST | ||||||||
| Address2: | SUITE 1C | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405362579 | ||||||||
| FaxNumber: | 5405367238 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 AMHERST ST | ||||||||
| Address2: | SUITE 1C | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405362579 | ||||||||
| FaxNumber: | 5405367238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 04/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5407223595 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 3810010076 | 05 | WV | MEDICAID | 1578754123 | 05 | VA | MEDICAID | DG6699 | 01 | VA | RR MEDICARE | OTHER |