Provider Demographics
NPI:1033102942
Name:CARILION MEDICAL CENTER
Entity Type:Organization
Organization Name:CARILION MEDICAL CENTER
Other - Org Name:CARILION ROANOKE MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONAL SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5352
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-328-2167
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-328-2167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1840282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0174559000OtherWEST VIRGINIA MEDICAID
VA0000248OtherSLH
VA144411OtherANTHEM
VA032355700OtherBLACK LUNG
VA101887000OtherMAGELLAN
VAV246P-01224OtherVA HOSPITAL
VA143676OtherSOUTHERN HEALTH
VA4900243Medicaid
VA4900243Medicaid
VA144411OtherANTHEM