Provider Demographics
NPI:1114924651
Name:CARILION SURGERY CENTER NEW RIVER VALLEY, LLC
Entity Type:Organization
Organization Name:CARILION SURGERY CENTER NEW RIVER VALLEY, LLC
Other - Org Name:CARILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5715
Mailing Address - Street 1:2901 LAMB CIR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6347
Mailing Address - Country:US
Mailing Address - Phone:540-639-5888
Mailing Address - Fax:540-639-9363
Practice Address - Street 1:2901 LAMB CIR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6347
Practice Address - Country:US
Practice Address - Phone:540-639-5888
Practice Address - Fax:540-639-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2017-06-01
Deactivation Date:2017-05-03
Deactivation Code:
Reactivation Date:2017-06-01
Provider Licenses
StateLicense IDTaxonomies
VAOH 644261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010142512Medicaid
VA192949757Medicare PIN