Healthcare Provider Details

I. General information

NPI: 1114975331
Provider Name (Legal Business Name): BEDFORD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 OAKWOOD ST
BEDFORD VA
24523-1213
US

IV. Provider business mailing address

213 S JEFFERSON ST
ROANOKE VA
24011-1705
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5512
  • Fax: 540-224-5507
Mailing address:
  • Phone: 540-224-5512
  • Fax: 540-224-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DOUG DAVENPORT
Title or Position: CFO
Credential:
Phone: 434-200-4708