Healthcare Provider Details

I. General information

NPI: 1073164539
Provider Name (Legal Business Name): SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E MAIN ST RM 2
MARION VA
24354-3318
US

IV. Provider business mailing address

PO BOX 297
MEADOWVIEW VA
24361-0297
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-8185
  • 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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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