Healthcare Provider Details

I. General information

NPI: 1194511568
Provider Name (Legal Business Name): STUART COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
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: 336-944-6420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LARRY HENSON
Title or Position: RCD, AUTHORIZED OFFICIAL
Credential:
Phone: 336-944-6420