Provider Demographics
NPI:1205854056
Name:JOHNSTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHNSTON MEMORIAL HOSPITAL
Other - Org Name:JOHNSTON MEMORIAL HOSPITAL REFERENCE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-676-7203
Mailing Address - Street 1:351 COURT ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2921
Mailing Address - Country:US
Mailing Address - Phone:276-676-7000
Mailing Address - Fax:
Practice Address - Street 1:351 COURT ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2921
Practice Address - Country:US
Practice Address - Phone:276-676-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA142849OtherANTHEM BLUE CROSS