Potomac Hospital Corporation of Prince William

NPI #1366718215 in Lake Ridge, Virginia

Provider Information

NPI Number: 1366718215
Entity Type: Organization
Organization Name: Potomac Hospital Corporation of Prince William
Subpart: Yes (part of a larger organization)
Parent Organization: SENTARA HEALTHCARE
Primary Specialty: Clinic/Center
Enumeration Date: Mar 26, 2012
Last Updated: Mar 26, 2012

Practice Location

Address: 12825 MINNIEVILLE ROAD
City: Lake Ridge
State: Virginia
ZIP Code: 22192-9998
Phone: (703) 523-9800

Authorized Official

Name: MR. ROBERT A BROERMANN
Title: SVP/CFO
Phone: (757) 455-7020

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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