1316000516 NPI number — CARILION NEW RIVER VALLEY MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316000516 NPI number — CARILION NEW RIVER VALLEY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARILION NEW RIVER VALLEY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316000516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 S JEFFERSON ST STE 1006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24011-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-224-5715
Provider Business Mailing Address Fax Number:
540-224-5684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 TYLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24073-6374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-731-2000
Provider Business Practice Location Address Fax Number:
540-731-2011
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRISETTI
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONAL SUPPORT
Authorized Official Telephone Number:
540-224-5352

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH0930 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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