Organization Active NPI

Carilion Healthcare Corporation

Doing business as Carilion Clinic Family Medicine

  • Rural Health Clinic/Center
  • Rocky Mount, VA
National Provider Identifier
1639794548
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARILION HEALTHCARE CORPORATION
Doing business as
Carilion Clinic Family Medicine
Practice address
796 Old Franklin Tpke
Rocky Mount, VA 24151-5507
Phone
(540) 483-5168
NPI assigned
Jun 16, 2020
Last updated
May 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CARILION HEALTHCARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Authorized official

Name
Nicole Grisetti
Title
Director of Operational Support
Phone
(540) 224-5352

Specialties & licenses 1

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

Addresses

Primary practice location

796 Old Franklin Tpke
Rocky Mount, VA 24151-5507

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5250

Other names 1

  • Carilion Clinic Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Part of
CFM Family Practice Cli

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Sep 8, 2020 Change of OwnershipThis provider was the seller Carilion ClinicCCN 493450, VA, NPI 1275151318

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1639794548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5250",
            "fax_number": "540-224-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "796 OLD FRANKLIN TPKE",
            "city": "ROCKY MOUNT",
            "state": "VA",
            "postal_code": "241515507",
            "telephone_number": "540-483-5168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARILION HEALTHCARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARILION HEALTHCARE CORPORATION",
        "enumeration_date": "2020-06-16",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "GRISETTI",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONAL SUPPORT",
        "authorized_official_telephone_number": "540-224-5352"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carilion Clinic Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carilion Clinic Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocky Mount, VA

Sources for this page

Verify at the official NPI Registry.