Basic Information
| Provider Information | |||||||||
| NPI: | 1376536573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARILION NEW RIVER VALLEY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 S JEFFERSON ST STE 1006 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240111713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402245715 | ||||||||
| FaxNumber: | 5402245684 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 LAMB CIRCLE | ||||||||
| Address2: | |||||||||
| City: | CHRISTIANSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240736374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407312000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR SPR | ||||||||
| AuthorizedOfficialTelephone: | 5402245715 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H 1838 | VA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 007672 | 01 | VA | ANTHEM HOSPITAL | OTHER | 0168640000 | 01 | VA | WEST VIRGINIA MEDICAID | OTHER | 147097 | 01 | VA | SOUTHERN HEALTH | OTHER | 4900421 | 05 | VA | MEDICAID | 0000426 | 01 | VA | SLH | OTHER | 354361000 | 01 | VA | MAGELLAN | OTHER | 37398500 | 01 | VA | BLACK LUNG | OTHER |