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NPI Code Detail

MEDICARE: BEDFORD MEDICAL, INC.

MEDICARE: BEDFORD MEDICAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianVA
2207Q00000XFamily Medicine PhysicianVA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C04478OTHERMEDICARE PTAN

General Provider Information

NPI Number : 1255332763
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEDFORD MEDICAL, INC.
Provider Business Mailing Address
First Line : 171 W MAIN ST
Second Line :
City : BEDFORD
State : VA
Zip : 24523-1950
Country : US
Telephone Number : 540-586-7273
Fax Number : 540-586-2887
Provider Business Practice Location Address
First Line : 171 W MAIN ST
Second Line :
City : BEDFORD
State : VA
Zip : 24523-1950
Country : US
Telephone Number : 540-586-7273
Fax Number : 540-586-2887
Authorized Official
Title or Position : ADMIN. MANAGER
Name : MS. PAM ROTHGEB
Credential :
Telephone Number : 540-586-7273
Provider Enumeration Date : 08/09/2005
Last Update Date : 10/24/2013

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1285814111 — ANTHONY D. BAILEY, D.D.S., INC
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Directions to “BEDFORD MEDICAL, INC. ” Practice Location

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