Healthcare Provider Details

I. General information

NPI: 1528330552
Provider Name (Legal Business Name): CLINCH VALLEY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 2ND ST
RICHLANDS VA
24641-2305
US

IV. Provider business mailing address

103 POWELL CT
BRENTWOOD TN
37027-5079
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-9577
  • Fax: 276-963-4747
Mailing address:
  • Phone: 615-372-8500
  • Fax: 615-372-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS M. WEISS
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8510