Provider Demographics
NPI:1669454781
Name:CLINCH VALLEY PHYSICIANS INC
Entity Type:Organization
Organization Name:CLINCH VALLEY PHYSICIANS INC
Other - Org Name:CLINCH VALLEY PHYSICIANS LABORATORY DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CRAWFORD
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-964-6771
Mailing Address - Street 1:PO BOX CVPI
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1100
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:276-964-1314
Practice Address - Street 1:1 CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1102
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINCH VALLEY PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-15
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4981120Medicaid
VA4981120Medicaid