Provider Demographics
NPI:1508805540
Name:PULASKI COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:PULASKI COMMUNITY HOSPITAL INC
Other - Org Name:LEWISGALE HOSPITAL PULASKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAASKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-994-8311
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-0759
Mailing Address - Country:US
Mailing Address - Phone:540-994-8100
Mailing Address - Fax:540-994-8333
Practice Address - Street 1:2400 LEE HWY N
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2326
Practice Address - Country:US
Practice Address - Phone:540-994-8100
Practice Address - Fax:540-994-8333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULASKI COMMUNITY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
495271Medicare Oscar/Certification