Healthcare Provider Details

I. General information

NPI: 1255332763
Provider Name (Legal Business Name): BEDFORD MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 W MAIN ST
BEDFORD VA
24523-1950
US

IV. Provider business mailing address

171 W MAIN ST
BEDFORD VA
24523-1950
US

V. Phone/Fax

Practice location:
  • Phone: 540-586-7273
  • Fax: 540-586-2887
Mailing address:
  • Phone: 540-586-7273
  • Fax: 540-586-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MS. PAM ROTHGEB
Title or Position: ADMIN. MANAGER
Credential:
Phone: 540-586-7273