Organization
SMYTH COUNTY COMMUNITY HOSPITAL
Active
Other names
MSMG FP GLDE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN H EICHORN (SENIOR VP AND CFO)
(423) 431-1017
Entity
Organization
Contact information
Practice address
636 S MONTE VISTA DR, GLADE SPRING, VA 24340-2712
(276) 429-5163
(276) 429-5515
Mailing address
636 S MONTE VISTA DR, GLADE SPRING, VA 24340-2712
(276) 429-5163
(276) 429-5515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073519377
—
VA
01
—
DH1427
RAILROAD MEDICARE
VA
01
—
DV0636
RAILROAD MEDICARE
VA
Enumeration date
11/26/2013
Last updated
02/14/2017
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