LAKE RIDGE
NPI 1366718215
Clinic/Center in Lake Ridge, VA

Q: What is Potomac Hospital Corporation Of Prince William's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since March 26, 2012

12825 MINNIEVILLE ROAD, LAKE RIDGE, VA 22192(703) 523-9800 Get Directions Write a Review

NPPES record last updated: March 26, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Lake Ridge NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE RIDGE (NPI 1366718215) is a healthcare organization registered as a clinic/center in Lake Ridge, Virginia and active in the NPI registry since March 2012. The organization lists Robert A Broermann, Svp/cfo, as its authorized official.

NPPES Registry Identity

NPI1366718215

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NamePOTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM

Location Address12825 MINNIEVILLE ROADLake Ridge, VA 22192-9998

Mailing Address12825 Minnieville RoadLake Ridge, VA 22192-9998 · (703) 523-9800

Phone(703) 523-9800

Organization SubpartYesParent: Sentara Healthcare

Authorized OfficialRobert A BroermannSvp/cfo · (757) 455-7020

Enumeration DateMarch 26, 2012

✔ NPI 1366718215 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

Definition

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).

12825 MINNIEVILLE ROAD, Lake Ridge, VA 22192

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Other Names 1

Doing Business AsLake Ridge

Other Identifiers 1

Medicare OSCAR/certification490113VA

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GREATER METROPOLITAN ORTHOPAEDIC INSTITUTE

Orthopaedic Surgery

12825 MINNIEVILLE ROAD, SUITE 201/203
WOODBRIDGE, VA 22192

Prince William County (301) 856-1682

LAKE RIDGE ANESTHESIA LLC

Anesthesiology

12825 MINNIEVILLE ROAD, # 220
WOODBRIDGE, VA 22192

Prince William County (301) 829-7386

LAKE RIDGE AMBULATORY SURGERY CENTER, LLC

Clinic/Center (Ambulatory Surgical)

12825 MINNIEVILLE ROAD, SUITE 204
WOODBRIDGE, VA 22192

Prince William County (703) 357-9568

ELETHIA V WAMPLER

Physical Therapist

12825 MINNIEVILLE ROAD, SUITE 203
WOODBRIDGE, VA 22192

Prince William County (703) 971-3701

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Potomac Hospital Corporation Of Prince William's NPI number?

The NPI number for Potomac Hospital Corporation Of Prince William is 1366718215. It was assigned to this organization in the NPPES registry on March 26, 2012. The provider is doing business as Lake Ridge.

Where is Potomac Hospital Corporation Of Prince William located?

Potomac Hospital Corporation Of Prince William is located at 12825 Minnieville Road, Lake Ridge, VA 22192. The listed phone number is (703) 523-9800.

What is Potomac Hospital Corporation Of Prince William's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Potomac Hospital Corporation Of Prince William was last updated on March 26, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.