Healthcare Provider Details

I. General information

NPI: 1508805540
Provider Name (Legal Business Name): PULASKI COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LEE HWY N
PULASKI VA
24301-2326
US

IV. Provider business mailing address

PO BOX 759
PULASKI VA
24301-0759
US

V. Phone/Fax

Practice location:
  • Phone: 540-994-8100
  • Fax: 540-994-8333
Mailing address:
  • Phone: 540-994-8100
  • Fax: 540-994-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY W. HAASKEN
Title or Position: CFO
Credential:
Phone: 540-994-8311