Healthcare Provider Details

I. General information

NPI: 1942630082
Provider Name (Legal Business Name): SMYTH COUNTY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 S MONTE VISTA DR
GLADE SPRING VA
24340-2712
US

IV. Provider business mailing address

636 S MONTE VISTA DR
GLADE SPRING VA
24340-2712
US

V. Phone/Fax

Practice location:
  • Phone: 276-429-5163
  • Fax: 276-429-5515
Mailing address:
  • Phone: 276-429-5163
  • Fax: 276-429-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARVIN H EICHORN
Title or Position: SENIOR VP AND CFO
Credential:
Phone: 423-431-1017