MEDICARE: SMYTH COUNTY COMMUNITY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H1902	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104940	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1356347082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMYTH COUNTY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	7021 WEST LEE HIGHWAY
Second Line	:
City	:	RURAL RETREAT
State	:	VA
Zip	:	24368
Country	:	US
Telephone Number	:	276-686-4148
Fax Number	:	276-686-6046

Provider Business Practice Location Address
First Line	:	7021 WEST LEE HIGHWAY
Second Line	:
City	:	RURAL RETREAT
State	:	VA
Zip	:	24368-0000
Country	:	US
Telephone Number	:	276-686-4148
Fax Number	:	276-686-6046

Authorized Official
Title or Position	:	CEO
Name	:	MS. LINDA WHITE
Credential	:
Telephone Number	:	276-782-1240

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	01/19/2011

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Directions to “SMYTH COUNTY COMMUNITY HOSPITAL ” Practice Location

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