Healthcare Provider Details

I. General information

NPI: 1831593920
Provider Name (Legal Business Name): IPS OF WINCHESTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33674 OLD VALLEY PIKE
STRASBURG VA
22657-3704
US

IV. Provider business mailing address

148 LINDEN DR SUITE 101
WINCHESTER VA
22601-6902
US

V. Phone/Fax

Practice location:
  • Phone: 540-465-3751
  • Fax: 540-465-5008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS E HOLTHUS
Title or Position: PHYSICIAN
Credential: MD
Phone: 540-465-3751