Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Potomac Hospital Corporation of Prince William

Organization Clinic/Center · NPI 1366718215

Potomac Hospital Corporation of Prince William is a Clinic/Center in Lake Ridge, Virginia. Licensed in Virginia. Registered with an NPI since 2012.

Licensed in
VA
In the registry since
2012

Practice location Address checks out

12825 Minnieville Rd
Lake Ridge, VA 22192-9998
Phone: (703) 523-9800
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X (VA)

Record details

NPI number1366718215
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationSentara Healthcare
Authorized official Robert Broermann — Svp/Cfo · (757) 455-7020
Other names Lake Ridge
NPI enumeratedMarch 26, 2012
Last updated in NPPESMarch 26, 2012
Mailing address12825 Minnieville Road, Lake Ridge, VA 22192-9998