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General NPI Number Information
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NPI Number | 1366718215
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Entity Type | Organization
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Legal Business Name | POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 12825 MINNIEVILLE ROAD
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City | LAKE RIDGE
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State | VA
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Zip | 22192-9998
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Country | US
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Telephone | 703-523-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 12825 MINNIEVILLE ROAD
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City | LAKE RIDGE
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State | VA
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Zip | 22192-9998
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Country | US
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Telephone | 703-523-9800
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Fax |
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Authorized Official
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Title or Position | SVP/CFO
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Name | MR. ROBERT A BROERMANN
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Credential |
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Telephone | 757-455-7020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | VA
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