Provider Demographics
NPI:1538102827
Name:CLINCH VALLEY MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:CLINCH VALLEY MEDICAL CENTER INC.
Other - Org Name:CLINCH VALLEY MEDICAL CENTER - SNF UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:6801 GOVERNOR GC PEERY HWY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2194
Practice Address - Country:US
Practice Address - Phone:276-596-6000
Practice Address - Fax:276-596-6009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINCH VALLEY MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004951816Medicaid
VA000756OtherBLUE CROSS SNF PROVIDER NUMBER
VA004951816Medicaid