Organization
DICKENSON COMMUNITY HOSPITAL, INC.
Active
Other names
DMA BEHAVIORAL HEALTH GREEN OAK
Organization subpart
No
Provider details
NPI number
Authorized official
CARL KILGORE (PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
364 HOSPITAL DR, CLINTWOOD, VA 24228
(276) 926-0330
(276) 926-0254
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
(423) 282-1657
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871517151
—
VA
01
—
DC7419
RR MEDICARE
VA
Enumeration date
04/10/2014
Last updated
05/02/2025
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