Provider Demographics
NPI:1275695256
Name:COMMONWEALTH OF VIRGINIA CATAWBA HOSPITAL
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA CATAWBA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO FACILTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, VCO
Authorized Official - Phone:540-375-4200
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:VA
Mailing Address - Zip Code:24070-0200
Mailing Address - Country:US
Mailing Address - Phone:540-375-4200
Mailing Address - Fax:540-395-4249
Practice Address - Street 1:5525 CATAWBA HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:VA
Practice Address - Zip Code:24070-2115
Practice Address - Country:US
Practice Address - Phone:540-375-4200
Practice Address - Fax:540-375-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064767OtherTDO - MEDICAID
VA004920040Medicaid
VA004920040Medicaid
VA010064767OtherTDO - MEDICAID