Provider Demographics
NPI:1629860275
Name:CLINCH RIVER HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:CLINCH RIVER HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-467-2201
Mailing Address - Street 1:17633 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DUNGANNON
Mailing Address - State:VA
Mailing Address - Zip Code:24245-3929
Mailing Address - Country:US
Mailing Address - Phone:276-467-2201
Mailing Address - Fax:
Practice Address - Street 1:17633 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DUNGANNON
Practice Address - State:VA
Practice Address - Zip Code:24245-3929
Practice Address - Country:US
Practice Address - Phone:276-467-2201
Practice Address - Fax:276-467-2673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINCH RIVER HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental