=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841603776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEDFORD MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2014
-----------------------------------------------------
Last Update Date | 05/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 WHITFIELD DR SUITE C
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24523-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-1816
-----------------------------------------------------
Fax | 434-200-6638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1920 ATHERHOLT RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-1816
-----------------------------------------------------
Fax | 434-200-6638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP CFO
-----------------------------------------------------
Name | MR. LEWIS C ADDISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-200-4708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | EXEMPT
-----------------------------------------------------
License Number State |
-----------------------------------------------------