CARILION HEALTHCARE CORPORATION

Provider Demographics

• NPI: 1447206370
• Name: CARILION HEALTHCARE CORPORATION
• Entity Type: Organization
• Organization Name: CARILION HEALTHCARE CORPORATION
• Other - Org Name: CARILION MEDICAL GROUP
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: DIRECTOR OF OPERATIONAL SUPPORT
• Authorized Official - First Name: NICOLE
• Authorized Official - Last Name: GRISETTI
• Authorized Official - Phone: 540-224-5352
• Mailing Address - Street 1: 213 S JEFFERSON ST STE 1006
• 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: 213 S JEFFERSON ST
• Practice Address - Street 2: SUITE 416
• Practice Address - City: ROANOKE
• Practice Address - State: VA
• Practice Address - Zip Code: 24011-1705
• Practice Address - Country: US
• Practice Address - Phone: 540-224-5715
• Practice Address - Fax: 540-224-5606
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-25
• Last Update Date: 2023-05-25

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	CA3863	Other	MEDICARE RAILROAD GROUP #
	C04963	Medicare PIN
	C04985	Medicare PIN
	C06525	Medicare PIN
	C03739	Medicare PIN
	C04991	Medicare PIN
	C04995	Medicare PIN
	C05478	Medicare PIN
	C04847	Medicare PIN
	C04965	Medicare PIN
	C04999	Medicare PIN
	C05480	Medicare PIN
	C06040	Medicare PIN
	C07002	Medicare PIN
	C03387	Medicare PIN
	C04971	Medicare PIN
	C04989	Medicare PIN
	C04994	Medicare PIN
	C04996	Medicare PIN
	C04997	Medicare PIN
	C06908	Medicare PIN
	C04241	Medicare PIN
	C04653	Medicare PIN
	C05105	Medicare PIN
	C09617	Medicare PIN
	C01118	Medicare PIN
	C04967	Medicare PIN
	C04981	Medicare PIN
	C08905	Medicare PIN
	C04982	Medicare PIN
	C05507	Medicare PIN
	C08304	Medicare PIN
	CA3863	Other	MEDICARE RAILROAD GROUP #
	C04984	Medicare PIN
	C04986	Medicare PIN
	C04990	Medicare PIN
	C05129	Medicare PIN
	C06022	Medicare PIN
	C06023	Medicare PIN
	C03386	Medicare PIN