1295914679 NPI number — CLINCH VALLEY NEPHROLOGY,INC.

Table of content: (NPI 1295914679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295914679 NPI number — CLINCH VALLEY NEPHROLOGY,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINCH VALLEY NEPHROLOGY,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:
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:
1295914679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2951 FRONT ST
Provider Second Line Business Mailing Address:
CLINCH VALLEY MEDICAL PLAZA, SUITE 1600
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24641-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-964-4001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2951 FRONT ST
Provider Second Line Business Practice Location Address:
CLINCH VALLEY MEDICAL PLAZA, SUITE 1600
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-964-4001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
IN
Authorized Official Middle Name:
YOUNG
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
276-964-4001

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  0101029175 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5879884 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com