Healthcare Provider Details

I. General information

NPI: 1497719207
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA WESTERN STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RICHMOND AVE
STAUNTON VA
24401-9146
US

IV. Provider business mailing address

PO BOX 2500 1301 RICHMOND RD.
STAUNTON VA
24402-2500
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-8200
  • Fax: 540-332-8197
Mailing address:
  • Phone: 540-332-8200
  • Fax: 540-332-8197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK W BARBER
Title or Position: HOSPITAL DIRECTOR
Credential: M.D.
Phone: 540-332-8200