Buchanan General Hospital Inc
Organization Active NPI Rural Health Clinic/Center · Grundy, VA
NPI 1891402228 · NPPES record last updated Nov 4, 2022
Key facts
- NPI
- 1891402228
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BUCHANAN GENERAL HOSPITAL INC
- Practice address
- 1520 Slate Creek Rd Ste 204
Grundy, VA 24614-6975 - Phone
- (276) 935-1385
- NPI assigned
- Nov 4, 2022
- Organization subpart
- No
Authorized official
- Name
- Kimetha Lea Boyd
- Title
- Chief Financial Officer
- Phone
- (276) 935-1111
Owners & managing parties with NPI records 1
-
Bradley Dean Vandyke, D.C.
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Related certifications (CCN) 1
Practitioners 10
-
Anthony Julius Cichocki, CRNA
-
Christopher S Copley, D.O.
-
Latisha Mechele Hilton, D.O.
-
Angela Horn, FNP
-
Freda Y Powers, FNP
-
Sainath Gaddam, MBBS, MD
-
Tamanna Nahar, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Rural health clinic certification: CCN 493468
- Legal name
- BUCHANAN GENERAL HOSPITAL INC.
- Doing business as
- MOUNTAIN VIEW MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 13, 2023
- Last certification
- Dec 13, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 25, 1971 in VA
- Enrollment address
- 1520 Slate Creek Rd
Ste 204
Grundy, VA 24614-6975 - Related CCNs
- 490127
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Harold Musick |
Corporate Director | Oct 13, 2013 | |
| Danny Elswick |
Corporate Director | Apr 6, 2004 | |
| Mary Ruth Spencer |
Corporate Director | Dec 1, 2009 | |
| Tommy Roger Coleman |
Corporate Director | Jan 1, 2011 | |
| Willis Smith |
Corporate Director | Jan 1, 2012 | |
| David W Tolliver |
Corporate Director | Sep 1, 2011 | |
| Robert Ruchti |
Corporate Director | Dec 28, 2011 | |
| W-2 Managing Employee |
Dec 28, 2011 | ||
| James Wayne Childress |
Corporate Director | Jan 1, 2010 | |
| Bradley D Vandyke |
Corporate Director | Feb 28, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230329003391 | VA | Part a Provider - Rural Health Clinic | 4688581663 | Practice locations: Grundy, VA |
National Provider Directory
- Tax ID family
- Jaitly Rakesh MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1520 Slate Creek Rd Ste 204
Grundy, VA 24614-6975
Mailing address
1520 Slate Creek Rd Ste 204
Grundy, VA 24614-6975
Phone (276) 935-1385
Other names
- Mountain View Medical Clinic
Other providers in Grundy, VA
- Buchanan General Hospital Inc
- Buchanan General Hospital Inc
- Buchanan General Hospital Inc
- Buchanan General Hospital Inc
- Buchanan General Hospital Inc
- Buchanan General Hospital Inc.
- Buchanan General Hospital, Inc
- Buchanan Health Care LLC
- Buchanan Health Center Inc
- Buchanan Health Diabetes Center
All providers in Grundy, VA · Rural Health Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.