NPIMap

Organization Active NPI

Clinch Valley Urology, LLC

  • Urology Physician
  • Richlands, VA
National Provider Identifier
1114955168
Registry record updated Apr 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CLINCH VALLEY UROLOGY, LLC
Practice address
6719 Gov G. C. Peery Hwy
Suite 1800
Richlands, VA 24641-2055
Phone
(276) 596-6659
Fax
(276) 596-6658
NPI assigned
Jun 29, 2006
Last updated
Apr 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jess Judy
Title
President
Phone
(615) 565-1508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

6719 Gov G. C. Peery Hwy
Suite 1800
Richlands, VA 24641-2055

Mailing address

6719 Gov G. C. Peery Hwy
Suite 3650
Richlands, VA 24641-2055
Phone (276) 596-6773

Other identifiers 1

IdentifierTypeStateIssuer
1114955168MedicaidVA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1065456Clinch Valley Urology, LLC6719 Gov G C Perry Hwy Suite 1800, Richlands, VA 24641Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory

Locations

2951 W FRNT St Ste 1800
Ste 1800
Richlands, VA 24641
Phone (276) 596-6655

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271203200000",
    "number": "1114955168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 GOV G. C. PEERY HWY",
            "address_2": "SUITE 3650",
            "city": "RICHLANDS",
            "state": "VA",
            "postal_code": "246412055",
            "telephone_number": "276-596-6773",
            "fax_number": "866-803-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 GOV G. C. PEERY HWY",
            "address_2": "SUITE 1800",
            "city": "RICHLANDS",
            "state": "VA",
            "postal_code": "246412055",
            "telephone_number": "276-596-6659",
            "fax_number": "276-596-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINCH VALLEY UROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2010-04-14",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-565-1508"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114955168",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richlands, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.