1205882396 NPI number — PULASKI COMMUNITY HOSPITAL INC

Table of content: (NPI 1205882396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205882396 NPI number — PULASKI COMMUNITY HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULASKI COMMUNITY HOSPITAL INC
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:
LEWISGALE HOSPITAL PULASKI
Provider Other Organization Name Type Code:
3
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:
1205882396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 759
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULASKI
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24301-0759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-994-8100
Provider Business Mailing Address Fax Number:
540-994-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 LEE HWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULASKI
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24301-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-994-8100
Provider Business Practice Location Address Fax Number:
540-994-8333
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAASKEN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
540-994-8311

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4900116 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030807800 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0490116 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223904 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004901169 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007622 . This is a "WELLPOINT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0174779000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094037200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 362395000 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".




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