# DICKENSON MEDICAL ASSOCIATES A DEPARTMENT OF DICKENSON COMMUNITY HOSPI

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DICKENSON COMMUNITY HOSPITAL, INC
- **Other names:** BHRHC Dickenson
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871517151
- **Legal business name:** DICKENSON COMMUNITY HOSPITAL, INC
- **Authorized official:** MARY LYNN KRUTAK (EVP/CFO)
- **Authorized official phone:** (423) 302-3423

## Contact information

- **Practice address:** 364 HOSPITAL DR, CLINTWOOD, VA 24228-6786
- **Practice address phone:** (276) 926-0200
- **Practice address fax:** (276) 926-6675
- **Mailing address:** 509 MED TECH PKWY STE 100, JOHNSON CITY, TN 37604-2579
- **Mailing address phone:** (423) 302-6567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101016773 | VA | — |
| 207Q00000X | Family Medicine Physician | 0101240240 | VA | — |
| 207R00000X | Internal Medicine Physician | 0102201380 | VA | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | 0017001384 | VA | — |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 08/12/2024