=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871574368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEDFORD MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2005
-----------------------------------------------------
Last Update Date | 05/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1613 OAKWOOD ST
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24523-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-1816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 41000
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24506-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-1816
-----------------------------------------------------
Fax | 434-200-6638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. PATTI JURKUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-587-3385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------