Provider Demographics
NPI:1851656870
Name:COEBURN CLINIC, INC
Entity Type:Organization
Organization Name:COEBURN CLINIC, INC
Other - Org Name:COEBURN HOSPITAL CLINIC, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURCHARAN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KANWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-395-6244
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:116 CENTER ST
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-1136
Mailing Address - Country:US
Mailing Address - Phone:276-395-6244
Mailing Address - Fax:276-395-3058
Practice Address - Street 1:116 CENTER ST
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-2200
Practice Address - Country:US
Practice Address - Phone:276-395-6244
Practice Address - Fax:276-395-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021217207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPENDINGOtherNUMBERS