Healthcare Provider Details

I. General information

NPI: 1891014015
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N MECKLENBURG AVENUE
SOUTH HILL VA
23970-1431
US

IV. Provider business mailing address

1755 N MECKLENBURG AVENUE
SOUTH HILL VA
23970-1431
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3151
  • Fax:
Mailing address:
  • Phone: 434-447-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ALLEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 804-628-1338