Basic Information
| Provider Information | |||||||||
| NPI: | 1174524094 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TWIN COUNTY REGIONAL HEALTHCARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GALAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243332227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762368181 | ||||||||
| FaxNumber: | 2762361715 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GALAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243332227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762368181 | ||||||||
| FaxNumber: | 2762361715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | NELSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2762383504 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H1909 | VA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 007674 | 01 | VA | ANTHEM | OTHER |