Organization
SHENANDOAH MEMORIAL HOSPITAL
Active
Other names
Shenandoah Memorial Wound Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE NEVADA JOHNSON (CREDENTIALING COORDINATOR)
(540) 536-0103
Entity
Organization
Contact information
Practice address
759 S MAIN ST, WOODSTOCK, VA 22664-1127
(540) 459-1100
(540) 459-1293
Mailing address
759 S MAIN ST, WOODSTOCK, VA 22664-1127
(540) 459-1100
(540) 459-1293
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK0882
MEDICARE RAILROAD
—
01
—
P00424037
MEDICARE RAILROAD
—
Enumeration date
03/07/2007
Last updated
07/12/2023
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