Organization
DICKENSON COMMUNITY HOSPITAL, INC.
Active
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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