MEDICARE: COLONIAL BEACH MEDICAL CENTER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1831128032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL BEACH MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	GARRISONVILLE
State	:	VA
Zip	:	22463-0099
Country	:	US
Telephone Number	:	540-657-9633
Fax Number	:	540-657-5925

Provider Business Practice Location Address
First Line	:	700 MCKINNEY BLVD
Second Line	:	STE. 12
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-1925
Country	:	US
Telephone Number	:	804-224-6322
Fax Number	:	804-224-2512

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	MR. KELL R. HOOVLER
Credential	:
Telephone Number	:	540-657-9633

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	08/22/2020

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Directions to “COLONIAL BEACH MEDICAL CENTER ” Practice Location

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