MEDICARE: COMMONWEALTH OF VIRGINIA WESTERN STATE HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000007816	OTHER	VA	ANTHEM BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497719207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH OF VIRGINIA WESTERN STATE HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 2500
Second Line	:	1301 RICHMOND RD.
City	:	STAUNTON
State	:	VA
Zip	:	24402-2500
Country	:	US
Telephone Number	:	540-332-8200
Fax Number	:	540-332-8197

Provider Business Practice Location Address
First Line	:	1301 RICHMOND AVE
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-9146
Country	:	US
Telephone Number	:	540-332-8200
Fax Number	:	540-332-8197

Authorized Official
Title or Position	:	HOSPITAL DIRECTOR
Name	:	DR. JACK W BARBER
Credential	:	M.D.
Telephone Number	:	540-332-8200

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	11/05/2009

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Directions to “COMMONWEALTH OF VIRGINIA WESTERN STATE HOSPITAL ” Practice Location

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