NPIMap

Organization Active NPI

Clinch Professional Physician Services LLC

  • Rural Health Clinic/Center
  • Pounding Mill, VA
National Provider Identifier
1386329902
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC
Practice address
111 Fashion Rd Ste D
Pounding Mill, VA 24637-1200
Phone
(276) 596-6375
Fax
(276) 963-0920
NPI assigned
Jun 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

111 Fashion Rd Ste D
Pounding Mill, VA 24637-1200

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names 1

  • Clinch Valley Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070709000505 VA Part B Supplier - Clinic/Group Practice 9436259223 Receives reassigned benefits from 82 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Richlands, VA; Cedar Bluff, VA; Bluefield, VA; Pounding Mill, VA
O20230721001729 VA Part A Provider - Rural Health Clinic 9436259223 Practice locations: Pounding Mill, VA

Rural health clinic certification: CCN 498944

Legal name
CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC
Doing business as
CLINCH VALLEY URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 28, 2023
Last certification
Nov 28, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Feb 20, 2007 in DE
Enrollment address
111 Fashion Rd
Ste D
Pounding Mill, VA 24637-1200

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
49D2108920Clinch Professional Physicians Services, LLC111 Fashion Road, Suite D, Pounding Mill, VA 24637Certificate of waiverFeb 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Clinch Professional Physician Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pamela Kane Individual Corporate OfficerVice President Jul 1, 2023
DSB Acquisition LLC Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2023 100%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Health Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2023 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Jul 1, 2023
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
Lifepoint Acquisition Corp Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2023 100%
Klaus Michael Boel Individual Corporate OfficerPresident Aug 19, 2024
W-2 Managing Employee Aug 19, 2024
Christopher J Monte Individual Corporate OfficerVice President Jul 1, 2023
Lifepoint VA Holdings Inc Organization, Brentwood, TN Corporation, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Legacy Lifepoint Health LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2023 100%

Facilities with the same owner 193

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 193

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1386329902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 FASHION RD STE D",
            "city": "POUNDING MILL",
            "state": "VA",
            "postal_code": "246371200",
            "telephone_number": "276-596-6375",
            "fax_number": "276-963-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinch Valley Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinch Valley Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pounding Mill, VA

Sources for this page

Verify at the official NPI Registry.