NPIMap

Organization Active NPI

Clinch Valley Nephrology,Inc.

  • Nephrology Physician
  • Richlands, VA
National Provider Identifier
1295914679
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101029175 Issued in VA
Legal business name
CLINCH VALLEY NEPHROLOGY,INC.
Practice address
2951 Front St
Clinch Valley Medical Plaza, Suite 1600
Richlands, VA 24641-2055
Phone
(276) 964-4001
NPI assigned
Nov 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2007

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

Authorized official

Name
In Young Park, M.D.
Title
C.E.O.
Phone
(276) 964-4001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 0101029175 VA Primary

Addresses

Primary practice location

2951 Front St
Clinch Valley Medical Plaza, Suite 1600
Richlands, VA 24641-2055

Mailing address

2951 Front St
Clinch Valley Medical Plaza, Suite 1600
Richlands, VA 24641-2055
Phone (276) 964-4001

Other identifiers 1

IdentifierTypeStateIssuer
5879884MedicaidVA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1295914679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2951 FRONT ST",
            "address_2": "CLINCH VALLEY MEDICAL PLAZA, SUITE 1600",
            "city": "RICHLANDS",
            "state": "VA",
            "postal_code": "246412055",
            "telephone_number": "276-964-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2951 FRONT ST",
            "address_2": "CLINCH VALLEY MEDICAL PLAZA, SUITE 1600",
            "city": "RICHLANDS",
            "state": "VA",
            "postal_code": "246412055",
            "telephone_number": "276-964-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINCH VALLEY NEPHROLOGY,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "IN",
        "authorized_official_middle_name": "YOUNG",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "276-964-4001",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101029175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5879884",
            "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 Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.