Virginia Department of Health
Organization Active NPI Multi-Specialty Clinic/Center · Clintwood, VA
NPI 1083675474 · NPPES record last updated Jun 10, 2011
Key facts
- NPI
- 1083675474
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- VIRGINIA DEPARTMENT OF HEALTH
- Practice address
- 334 Brush Creek Road
Clintwood, VA 24228-0768 - Phone
- (276) 926-4979
- Fax
- (276) 926-4426
- NPI assigned
- Mar 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Johnny Willis
- Title
- Business Manager
- Phone
- (276) 926-4979
Other NPIs on the same Medicare enrollment 45
Corporate family (same tax ID) 24
Practitioners 1
-
Noelle S Bissell, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000622 | VA | Part B Supplier - Clinic/Group Practice | 0547174369 |
Receives reassigned benefits from 30 practitioners 45 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Independence, VA; Prince George, VA; Jonesville, VA; Lawrenceville, VA; Lebanon, VA; Louisa, VA; Lynchburg, VA; Marion, VA… |
National Provider Directory
- Tax ID family
- Commonwealth of VA State
Locations
234 Valley St NW
Abingdon, VA 24210
341 Piedmont Ave
Bristol, VA 24201
Phone (276) 642-7335
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
334 Brush Creek Road
Clintwood, VA 24228-0768
Mailing address
PO Box 768
Clintwood, VA 24228-0768
Phone (276) 926-4979
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370009593 | Other | VA | RAILROAD MEDICARE |
Other names
- Dickenson County Health Department
Other providers in Clintwood, VA
- Kaynell Tickle
- Edward Lee Trent
- Tri-City Opticians, LLC
- Paula Vanover
- Kelli Viers
- Walgreen Co
- Walid Saado MD PC
- Kala Denise Wallace
- West End Pharmacy
- Leann Marie Yates
All providers in Clintwood, VA · Multi-Specialty Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.