LAKE RIDGE – NPI #1366718215
Clinic/Center

A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Health Care Provider Taxonomy Code for Clinic/Center

LAKE RIDGE is an AHC clinic located in LAKE RIDGE, VA. NPPES has assigned the NPI number 1366718215 to LAKE RIDGE on March 26, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “LAKE RIDGE” is a dba name, the actual legal business name for this organization is POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM. The primary taxonomy selected by this provider is 261Q00000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LAKE RIDGE below.

NPI Profile for
POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM

NPI Number
1366718215
Enumeration Date

(more than 14 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM
Doing Business As (dba): LAKE RIDGE
Primary location
12825 MINNIEVILLE ROAD
LAKE RIDGE, VA 22192-9998
Phone: (703) 523-9800 Fax:
Mailing address
Same as primary location
Organization Subpart
Yes - LAKE RIDGE is subpart of another organization.
Authorized Official
ROBERT BROERMANN
SVP/CFO
Phone: (757) 455-7020
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261Q00000X
- Clinic/Center (Primary)		 VA

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.