NPIMap

Organization Active NPI

Clinch Professional Physician Services LLC

  • Surgery Physician
  • Richlands, VA
National Provider Identifier
1609994284
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101240724 Issued in VA
Legal business name
CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC
Practice address
6719 Gov G. C. Peery Hwy
Suite 3650
Richlands, VA 24641-2055
Phone
(276) 596-6773
Fax
(866) 803-1898
NPI assigned
Mar 26, 2007
Last updated
Sep 24, 2024By the provider in NPPES
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 13

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X
Cardiovascular Disease Physician 207RC0000X
Gastroenterology Physician 207RG0100X
Hematology & Oncology Physician 207RH0003X
Pulmonary Disease Physician 207RP1001X
Medical Oncology Physician 207RX0202X
Orthopaedic Surgery Physician 207X00000X
Otolaryngology Physician 207Y00000X
Surgery Physician 208600000X 0101240724 VA Primary
Vascular Surgery Physician 2086S0129X
Urology Physician 208800000X

Addresses

Primary practice location

6719 Gov G. C. Peery Hwy
Suite 3650
Richlands, VA 24641-2055

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

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
Practice locations: Richlands, VA; Cedar Bluff, VA; Bluefield, VA; Pounding Mill, VA

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.

National Provider Directory

National Provider Directory

Locations

1535 Slate Creek Rd
Grundy, VA 24614
Phone (276) 935-1125

1114 E Main St
Lebanon, VA 24266
Phone (276) 415-9167

111 Fashion Rd
Pounding Mill, VA 24637

111 Fashion Rd
Ste D
Pounding Mill, VA 24637
Phone (276) 325-0461

6719 Governor Gc Peery Hwy
Ste 1
Richlands, VA 24641

6719 Governor Gc Peery Hwy
Ste 1800
Richlands, VA 24641
Phone (276) 596-6659

6719 Governor Gc Peery Hwy
Ste 2
Richlands, VA 24641

6719 Governor Gc Peery Hwy
Ste 2400
Richlands, VA 24641
Phone (276) 963-2535

6719 Governor Gc Peery Hwy
Ste 2600
Richlands, VA 24641
Phone (276) 963-0333

6719 Governor Gc Peery Hwy
Ste 2900
Richlands, VA 24641
Phone (276) 596-6780

Practitioners & affiliated clinicians

Practitioners 88

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 88

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1609994284",
    "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 3650",
            "city": "RICHLANDS",
            "state": "VA",
            "postal_code": "246412055",
            "telephone_number": "276-596-6773",
            "fax_number": "866-803-1898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINCH PROFESSIONAL PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101240724",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.