Provider Demographics
NPI:1356347082
Name:SMYTH COUNTY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SMYTH COUNTY COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-782-1240
Mailing Address - Street 1:7021 WEST LEE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:RURAL RETREAT
Mailing Address - State:VA
Mailing Address - Zip Code:24368
Mailing Address - Country:US
Mailing Address - Phone:276-686-4148
Mailing Address - Fax:276-686-6046
Practice Address - Street 1:7021 WEST LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368-0000
Practice Address - Country:US
Practice Address - Phone:276-686-4148
Practice Address - Fax:276-686-6046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMYTH COUNTY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-27
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA104940OtherANTHEM
VAC06828Medicare PIN