NPIMap

Organization Active NPI

Eastern State Hospital

  • Psychiatric Hospital
  • Williamsburg, VA
National Provider Identifier
1093047797
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
0101049272 Issued in VA
Legal business name
EASTERN STATE HOSPITAL
Practice address
4601 Ironbound Rd
Williamsburg, VA 23188-2648
Phone
(757) 253-4309
Fax
(757) 253-4625
NPI assigned
Feb 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John M Favret
Title
Hospital Director
Phone
(757) 253-5241

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 0101049272 VA Primary

Addresses

Primary practice location

4601 Ironbound Rd
Williamsburg, VA 23188-2648

Mailing address

4601 Ironbound Rd
Williamsburg, VA 23188-2648
Phone (757) 253-4309

National Provider Directory

National Provider Directory
Tax ID family
Eastern State Hospital GRP5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4601 Ironbound Rd
Williamsburg, VA 23188
Phone (757) 253-5161

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1093047797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 IRONBOUND RD",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231882648",
            "telephone_number": "757-253-4309",
            "fax_number": "757-253-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 IRONBOUND RD",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231882648",
            "telephone_number": "757-253-4309",
            "fax_number": "757-253-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-04",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "FAVRET",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "HOSPITAL DIRECTOR",
        "authorized_official_telephone_number": "757-253-5241",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "VA",
            "license": "0101049272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.