NPIMap

Organization Active NPI

Smyth County Community Hospital

  • Durable Medical Equipment & Medical Supplies
  • Marion, VA
National Provider Identifier
1750433389
Registry record updated Nov 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SMYTH COUNTY COMMUNITY HOSPITAL
Practice address
1152 Snider St
Marion, VA 24354-4216
Phone
(276) 782-9696
Fax
(276) 782-9886
NPI assigned
Jan 16, 2007
Last updated
Nov 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2015

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

Authorized official

Name
Mary Lynn Krutak
Title
SVP/Cfo
Phone
(423) 302-3374

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X TN Primary

Addresses

Primary practice location

1152 Snider St
Marion, VA 24354-4216

Mailing address

311 Princeton Rd
Johnson City, TN 37601-2026

Other identifiers 1

IdentifierTypeStateIssuer
009114726MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000352 VA Part A Provider - Hospital 0446168496 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marion, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750433389. Details of each certification follow.

Hospital certification: CCN 490038

Legal name
SMYTH COUNTY COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 26, 2008
Beds
170
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1961 in VA
Enrollment address
245 Medical Park Dr
Marion, VA 24354-1100
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Smyth County Community HospitalCCN 490038 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1152 Snider St
Marion, VA 24354
Phone (276) 782-9696

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Shane Hilton Individual Corporate OfficerEvp/Cfo Apr 4, 2024
Corporate DirectorEvp.Cfo Apr 4, 2024
Gregory Wilgocki Individual Corporate DirectorSVP Feb 1, 2018
W-2 Managing EmployeeSVP Feb 1, 2018
Ballad Health Organization, Johnson City, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2018 100%
Marvin Eichorn Individual Corporate OfficerEvp/Cao Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Mountain States Health Alliance Organization, Johnson City, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 10, 2021 100%
Buford Deaton Individual Corporate OfficerEvp/Coo Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Alan Levine Individual Corporate OfficerCeo/President Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Julie Bennett Individual Corporate OfficerEvp/Clo Feb 1, 2023
Corporate DirectorBoard Member Feb 1, 2023

Owners & managing parties with NPI records 21

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 21

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 234

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 234

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1750433389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1152 SNIDER ST",
            "city": "MARION",
            "state": "VA",
            "postal_code": "243544216",
            "telephone_number": "276-782-9696",
            "fax_number": "276-782-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMYTH COUNTY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "KRUTAK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "423-302-3374"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009114726",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, VA

Sources for this page

Verify at the official NPI Registry.