MEDICARE: SHENANDOAH MEMORIAL HOSPITAL INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	208800000X	Urology Physician
2	207Q00000X	Family Medicine Physician	VA
3	207RC0000X	Cardiovascular Disease Physician	VA
4	207T00000X	Neurological Surgery Physician	VA
5	207V00000X	Obstetrics & Gynecology Physician	VA
6	207X00000X	Orthopaedic Surgery Physician	VA
7	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1740711472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHENANDOAH MEMORIAL HOSPITAL INC.

Provider Business Mailing Address
First Line	:	9166 N CONGRESS ST
Second Line	:
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9422
Country	:	US
Telephone Number	:	540-459-1340
Fax Number	:	540-459-1349

Provider Business Practice Location Address
First Line	:	9166 N CONGRESS ST
Second Line	:
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9422
Country	:	US
Telephone Number	:	540-459-1340
Fax Number	:	540-459-1349

Authorized Official
Title or Position	:	MANGER, INSURANCE CREDENTIALING
Name	:	RENEE Y BAKER
Credential	:
Telephone Number	:	540-536-0231

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	06/03/2021

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