=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093909111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMYTH COUNTY COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2007
-----------------------------------------------------
Last Update Date | 02/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 TERRACE DR SUITE 202
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24354-4392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-781-7848
-----------------------------------------------------
Fax | 276-781-7849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 TERRACE DR SUITE 202
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24354-4392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-781-7848
-----------------------------------------------------
Fax | 276-781-7849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. LINDY P WHITE
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 276-782-1240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 0101226304
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------