Provider Demographics
NPI:1558697235
Name:TWIN COUNTY REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:TWIN COUNTY REGIONAL HOSPITAL
Other - Org Name:OUTPATIENT REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:276-236-1620
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2227
Mailing Address - Country:US
Mailing Address - Phone:276-236-1675
Mailing Address - Fax:276-236-1715
Practice Address - Street 1:607 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2209
Practice Address - Country:US
Practice Address - Phone:276-236-1675
Practice Address - Fax:276-236-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007694OtherBLUE CROSS
VA0490115Medicaid
VA490115Medicare Oscar/Certification