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General NPI Number Information
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NPI Number | 1356420673
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Entity Type | Organization
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Legal Business Name | MONTGOMERY REGIONAL HOSPITAL--CRNA
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3700 S MAIN ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-7017
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Country | US
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Telephone | 540-953-5123
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Fax | 540-961-4673
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Provider Business Mailing Address
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Address Line | 3700 S MAIN ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-7017
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Country | US
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Telephone | 540-953-5123
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Fax | 540-961-4673
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Authorized Official
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Title or Position | PATIENT ACCESS SUPVR
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Name | DEBRA A WICKLINE
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Credential |
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Telephone | 540-953-5123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0024097342
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License Number State | VA
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