Healthcare Provider Details

I. General information

NPI: 1073279170
Provider Name (Legal Business Name): SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LONG CRESCENT DR
BRISTOL VA
24201-3690
US

IV. Provider business mailing address

PO BOX 297
MEADOWVIEW VA
24361-0297
US

V. Phone/Fax

Practice location:
  • Phone: 276-496-4492
  • Fax:
Mailing address:
  • Phone: 276-496-4492
  • Fax: 276-695-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BRYAN HAYNES
Title or Position: CEO
Credential:
Phone: 276-496-4492