Provider Demographics
NPI:1902900202
Name:PCH OPERATIONS, LLC DBA R.J. REYNOLDS-PATRICK COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PCH OPERATIONS, LLC DBA R.J. REYNOLDS-PATRICK COUNTY MEMORIAL HOSPITAL
Other - Org Name:CRNA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-8678
Mailing Address - Street 1:18688 JEB STUART HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171
Mailing Address - Country:US
Mailing Address - Phone:276-694-3151
Mailing Address - Fax:276-694-8655
Practice Address - Street 1:18688 JEB STUART HIGHWAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-694-3151
Practice Address - Fax:276-694-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA330049OtherMAMSI
VA146602OtherBLUE CROSS
VA146602OtherBLUE CROSS
VAC0947Medicare ID - Type Unspecified