Basic Information
| Provider Information | |||||||||
| NPI: | 1396782215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMYTH COUNTY RADIOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838231 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 RADIO HILL RD | ||||||||
| Address2: | SMYTH CO COMM HOSPITAL | ||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243546587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838231 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | BLANKENSHIP | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2767838231 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CA9001 | 01 | VA | RR MEDICARE | OTHER | 065693 | 01 | VA | ANTHEM | OTHER |