Healthcare Provider Details

I. General information

NPI: 1366689747
Provider Name (Legal Business Name): CHIPPENHAM & JOHNSTON-WILLIS HOSPITALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR
RICHMOND VA
23235-4730
US

IV. Provider business mailing address

1401 JOHNSTON WILLIS DR
RICHMOND VA
23235-4730
US

V. Phone/Fax

Practice location:
  • Phone: 804-267-6814
  • Fax: 804-330-2325
Mailing address:
  • Phone: 804-267-6814
  • Fax: 804-330-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN FOSNESS
Title or Position: CFO
Credential:
Phone: 804-483-0813