Provider Demographics
NPI:1306835673
Name:CLINCH VALLEY PULMONOLOGY LLC
Entity Type:Organization
Organization Name:CLINCH VALLEY PULMONOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-964-6966
Mailing Address - Street 1:2951 WEST FRONT STREET
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-964-6966
Mailing Address - Fax:276-963-3690
Practice Address - Street 1:2951 WEST FRONT STREET
Practice Address - Street 2:SUITE 1000
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-964-6966
Practice Address - Fax:276-963-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0210133000Medicaid
VA1306835673Medicaid
VAC08972Medicare ID - Type Unspecified