=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104083385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINCHESTER MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 10/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 W CORK ST SUITE 145
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-3870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-536-5122
-----------------------------------------------------
Fax | 540-536-5340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 W CORK ST SUITE 145
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-3870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-536-5122
-----------------------------------------------------
Fax | 540-536-5340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | BAMBIE COMPHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-536-5122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------