=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356732432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEMORIAL REGIONAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2015
-----------------------------------------------------
Last Update Date | 02/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8260 ATLEE RD
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23116-1844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-764-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2131 CARBON HILL DR
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-878-8860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE ANESTHETIST
-----------------------------------------------------
Name | MRS. JENNIFER ZACHARY HOWE
-----------------------------------------------------
Credential | CRNA
-----------------------------------------------------
Telephone | 804-764-6536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 0024172337
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------