Healthcare Provider Details

I. General information

NPI: 1629860275
Provider Name (Legal Business Name): CLINCH RIVER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17633 VETERANS MEMORIAL HWY
DUNGANNON VA
24245-3929
US

IV. Provider business mailing address

17633 VETERANS MEMORIAL HWY
DUNGANNON VA
24245-3929
US

V. Phone/Fax

Practice location:
  • Phone: 276-467-2201
  • Fax: 276-467-2673
Mailing address:
  • Phone: 276-467-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: GARY W GILLIAM
Title or Position: EXECUTIVE DIRECTOR
Credential: FNP
Phone: 276-467-2201