MEDICARE: MONTGOMERY REGIONAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NR1301X	Rural Acute Care Hospital	0116021734	VA

General Provider Information

NPI Number	:	1811125404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	722 PARK ST
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-3137
Country	:	US
Telephone Number	:	202-299-6536
Fax Number	:

Provider Business Practice Location Address
First Line	:	722 PARK ST
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-3137
Country	:	US
Telephone Number	:	202-299-6536
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR OF MEDICAL
Name	:	SUZANNE BARNETTE
Credential	:
Telephone Number	:	540-953-5445

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	06/23/2009

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