NPIMap

Organization Active NPI

Montgomery Regional Hospital--Crna

  • Specialist
  • Blacksburg, VA
National Provider Identifier
1356420673
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
0024097342 Issued in VA
Legal business name
MONTGOMERY REGIONAL HOSPITAL--CRNA
Practice address
3700 S Main St
Blacksburg, VA 24060-7017
Phone
(540) 953-5123
Fax
(540) 961-4673
NPI assigned
Nov 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Debra A Wickline
Title
Patient Access Supvr
Phone
(540) 953-5123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 0024097342 VA Primary

Addresses

Primary practice location

3700 S Main St
Blacksburg, VA 24060-7017

Mailing address

3700 S Main St
Blacksburg, VA 24060-7017
Phone (540) 953-5123

National Provider Directory

National Provider Directory
Tax ID family
MNTG Reg Ta Reg Fam Crgrp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356420673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-953-5123",
            "fax_number": "540-961-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-953-5123",
            "fax_number": "540-961-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY REGIONAL HOSPITAL--CRNA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WICKLINE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PATIENT ACCESS SUPVR",
        "authorized_official_telephone_number": "540-953-5123"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0024097342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blacksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.