=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992748255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY WASHINGTON HEALTHCARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 01/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 SAM PERRY BLVD SUITE 120
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22401-4467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-741-1425
-----------------------------------------------------
Fax | 540-371-1968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 SAM PERRY BLVD SUITE 120
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22401-4467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-741-1425
-----------------------------------------------------
Fax | 540-371-1968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCE OFFICER
-----------------------------------------------------
Name | SEAN T. BARDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-741-1494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201002070
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------