1750937009 NPI number — SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC

Table of content: (NPI 1750937009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750937009 NPI number — SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS 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:
TAZEWELL - NEW DAY RECOVERY
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:
1750937009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADOWVIEW
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24361-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-496-4492
Provider Business Mailing Address Fax Number:
276-695-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
388 BEN BOLT AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24651-5386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-496-4492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAYNES
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
276-496-4492

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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