Provider Demographics
NPI:1093909111
Name:SMYTH COUNTY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SMYTH COUNTY COMMUNITY HOSPITAL
Other - Org Name:SMYTH REGIONAL SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:276-782-1240
Mailing Address - Street 1:1020 TERRACE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4392
Mailing Address - Country:US
Mailing Address - Phone:276-781-7848
Mailing Address - Fax:276-781-7849
Practice Address - Street 1:1020 TERRACE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4392
Practice Address - Country:US
Practice Address - Phone:276-781-7848
Practice Address - Fax:276-781-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09142Medicare PIN