Provider Demographics
NPI:1376536573
Name:CARILION NEW RIVER VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:CARILION NEW RIVER VALLEY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONAL SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5352
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:2900 LAMB CIRCLE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6374
Practice Address - Country:US
Practice Address - Phone:540-731-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1838282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007672OtherANTHEM HOSPITAL
VA354361000OtherMAGELLAN
VA4900421Medicaid
VA0168640000OtherWEST VIRGINIA MEDICAID
VA0000426OtherSLH
VA37398500OtherBLACK LUNG
VA147097OtherSOUTHERN HEALTH
VA=========OtherCHAMPUS
VA490042Medicare Oscar/Certification