Healthcare Provider Details

I. General information

NPI: 1386834547
Provider Name (Legal Business Name): JOHNSTON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7664
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7664
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-4050
  • Fax: 276-258-4056
Mailing address:
  • Phone: 276-258-4050
  • Fax: 276-258-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101239640
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101238469
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101237946
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110002132
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101221395
License Number StateVA

VIII. Authorized Official

Name: JOHN L JETER
Title or Position: CFO
Credential:
Phone: 276-258-2830