Healthcare Provider Details

I. General information

NPI: 1639365620
Provider Name (Legal Business Name): PCH OPERATIONS, LLC DBA RJ REYNOLDS-PATRICK COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18688 JEB STUART HWY
STUART VA
24171-1559
US

IV. Provider business mailing address

18688 JEB STUART HWY
STUART VA
24171-1559
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-8651
  • Fax: 276-694-8655
Mailing address:
  • Phone: 276-694-8651
  • Fax: 276-694-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberH1919
License Number StateVA

VIII. Authorized Official

Name: MR. JANICE F WILKINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 276-694-8678