Healthcare Provider Details

I. General information

NPI: 1285685727
Provider Name (Legal Business Name): DICKENSON COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 HOSPITAL DR
CLINTWOOD VA
24228-6786
US

IV. Provider business mailing address

311 PRINCETON RD STE 1
JOHNSON CITY TN
37601-2026
US

V. Phone/Fax

Practice location:
  • Phone: 276-926-0300
  • Fax: 276-926-0329
Mailing address:
  • Phone: 276-926-0300
  • Fax: 276-926-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH1918
License Number StateVA

VIII. Authorized Official

Name: SHANE EDWIN HILTON
Title or Position: EVP/CFO
Credential:
Phone: 423-302-3467