Provider Demographics
NPI:1639180359
Name:CATAWBA HOSPITAL
Entity type:Organization
Organization Name:CATAWBA HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-375-4201
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:5525 CATAWBA HOSPITAL DRIVE
Mailing Address - City:CATAWBA
Mailing Address - State:VA
Mailing Address - Zip Code:24070-0200
Mailing Address - Country:US
Mailing Address - Phone:540-375-4200
Mailing Address - Fax:540-375-4708
Practice Address - Street 1:5525 CATAWBA HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:VA
Practice Address - Zip Code:24070-2115
Practice Address - Country:US
Practice Address - Phone:540-375-4200
Practice Address - Fax:540-375-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010009693336L0003X, 3336I0012X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201000969OtherPHARMACY LICENSE
VA010227461Medicaid