Healthcare Provider Details

I. General information

NPI: 1952417735
Provider Name (Legal Business Name): SHENANDOAH MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 S MAIN ST
WOODSTOCK VA
22664-1127
US

IV. Provider business mailing address

759 S MAIN ST
WOODSTOCK VA
22664-1127
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-1124
  • Fax: 540-459-1120
Mailing address:
  • Phone: 540-459-1124
  • Fax: 540-459-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE NEVADA JOHNSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 540-536-0103