Provider Demographics
NPI:1952750762
Name:SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INCORPORATED
Entity Type:Organization
Organization Name:SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INCORPORATED
Other - Org Name:SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEM INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-496-4492
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-0729
Mailing Address - Country:US
Mailing Address - Phone:276-496-4492
Mailing Address - Fax:276-496-4839
Practice Address - Street 1:319 5TH AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370-3418
Practice Address - Country:US
Practice Address - Phone:276-496-4492
Practice Address - Fax:276-496-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8575Medicare PIN
49-1948Medicare PIN