Provider Demographics
NPI:1811668676
Name:CARILION HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:CARILION HEALTHCARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONAL SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-224-5352
Mailing Address - Street 1:213 S JEFFERSON ST STE 625
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5894
Mailing Address - Fax:
Practice Address - Street 1:1111 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4724
Practice Address - Country:US
Practice Address - Phone:540-855-6800
Practice Address - Fax:540-857-9710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARILION HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental