Provider Demographics
NPI:1134403090
Name:CLINCH VALLEY VASCULAR SURGERY ASSOCIATES
Entity type:Organization
Organization Name:CLINCH VALLEY VASCULAR SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASSADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-963-2400
Mailing Address - Street 1:6719 GOV G. C. PEERY HIGHWAY
Mailing Address - Street 2:2600
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-963-0333
Mailing Address - Fax:276-963-0222
Practice Address - Street 1:6719 GOV G. C. PEERY HIGHWAY
Practice Address - Street 2:2600
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-963-0333
Practice Address - Fax:276-963-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital