Healthcare Provider Details

I. General information

NPI: 1407252042
Provider Name (Legal Business Name): LEE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 HEALTH CARE DR
PENNINGTON GAP VA
24277-2853
US

IV. Provider business mailing address

PO BOX 577
PENNINGTON GAP VA
24277-0577
US

V. Phone/Fax

Practice location:
  • Phone: 276-346-7714
  • Fax:
Mailing address:
  • Phone: 276-546-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA POPE
Title or Position: TREASURER
Credential: CPA
Phone: 276-546-3600