Coeburn Clinic, Inc

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

0101021217 Issued in VA

Legal business name

COEBURN CLINIC, INC

Practice address

116 Center St
Coeburn, VA 24230-2200

Phone

(276) 395-6244

Fax

(276) 395-3058

NPI assigned

Jul 5, 2012

Last updated

Jul 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gurcharan Singh Kanwal, MD

Title

President

Phone

(276) 395-6244

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• COEBURN HOSPITAL CLINIC, INC Other name

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341446400000",
    "number": "1851656870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1136",
            "address_2": "116 CENTER ST",
            "city": "COEBURN",
            "state": "VA",
            "postal_code": "242301136",
            "telephone_number": "276-395-6244",
            "fax_number": "276-395-3058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 CENTER ST",
            "city": "COEBURN",
            "state": "VA",
            "postal_code": "242302200",
            "telephone_number": "276-395-6244",
            "fax_number": "276-395-3058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COEBURN CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-05",
        "last_updated": "2012-07-05",
        "status": "A",
        "authorized_official_last_name": "KANWAL",
        "authorized_official_first_name": "GURCHARAN",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "276-395-6244",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101021217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NUMBERS",
            "identifier": "PENDING",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COEBURN HOSPITAL CLINIC, INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Cardiovascular Disease Physician in Coeburn, VA
• Providers in Coeburn, VA by specialty
• Cardiovascular Disease Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; 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.