DICKENSON COMMUNITY HOSPITAL, INC. (NPI# 1679992358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679992358 |
| Entity Type | Organization |
| Organization Name | DICKENSON COMMUNITY HOSPITAL, INC. |
| Other Organization Name | DMA BEHAVIORAL HEALTH GREEN OAK |
| Practice Address |
364 Hospital Dr Clintwood VA 24228 |
| Mailing Address |
509 Med Tech Pkwy Ste 100 Johnson City TN 37604-2579 |
| Practice Telephone | 2769260330 |
| Practice Fax Number | 2769260254 |
| Mailing Telephone | 4239522120 |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2018-01-09 |
| Authorized Official Name | CARL KILGORE (PRESIDENT) |
| Authorized Official Telephone | 4239155185 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0809X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Adult |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | RR MEDICARE | DC7419 | 01 |
| VA | 1871517151 | 05 |
| Other Name | Type Code |
|---|---|
| DMA BEHAVIORAL HEALTH GREEN OAK | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619029105 | Dickenson Community Hospital, Inc. | Medicare Defined Swing Bed Unit | 312 Hospital Dr, Clintwood, VA 24228-6786 | 2007-01-17 |
| 1285685727 | Dickenson Community Hospital, Inc. | General Acute Care Hospital | 312 Hospital Dr, Clintwood, VA 24228-6786 | 2006-05-12 |
| Street Address |
364 HOSPITAL DR |
| City | CLINTWOOD |
| State | VA |
| Zip Code | 24228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912938192 | Lurton B Lyle | Family Medicine | 364 Hospital Dr, Clintwood, VA 24228 | 2006-07-05 |
| 1497205355 | Tristan Jade Yates | Nurse Practitioner | 364 Hospital Dr, Clintwood, VA 24228-6786 | 2016-10-04 |
| 1629318324 | Heather Dawn Blair | Nurse Practitioner | 364 Hospital Dr, Clintwood, VA 24228 | 2013-02-18 |
| 1043522329 | Roy R Deel | Internal Medicine | 364 Hospital Dr, Clintwood, VA 24228 | 2010-07-02 |
| 1871517151 | Dickenson Medical Associates A Department of Dickenson Community Hospi | Family Medicine | 364 Hospital Dr, Clintwood, VA 24228-6786 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851816953 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 5451 Dickenson Hwy, Clintwood, VA 24228 | 2017-08-09 |
| 1669902243 | Mountain States Health Alliance | Hospice Care, Community Based | 312 Hospital Dr Suite 1b, Clintwood, VA 24228 | 2017-06-15 |
| 1316476211 | Mountain States Health Alliance | Home Health | 312 Hospital Dr Suite 1a, Clintwood, VA 24228 | 2017-06-06 |
| 1134667009 | Amy Meade | Pharmacist | 342 Main Street, Clintwood, VA 24228 | 2017-02-10 |
| 1881087385 | Family Preservation Services, Inc | Community/Behavioral Health | 1381 Rose Ridge Ct, Clintwood, VA 24228 | 2015-03-09 |
| 1477951515 | Tauna Gulley | Nurse Practitioner | 233 Chase Street, Suite 100, Clintwood, VA 24228 | 2014-12-05 |
| 1740696152 | Family Preservation Services, Inc. | Community/Behavioral Health | 5123 Dickenson Highway, Clintwood, VA 24228 | 2014-07-07 |
| 1962816884 | Family Preservation Services, Inc | Community/Behavioral Health | 5123 & 5127 Dickenson Highway, Clintwood, VA 24228 | 2014-06-18 |
| 1003163643 | Family Preservation Services, Inc | Community/Behavioral Health | 150 Elementary Circle, Clintwood, VA 24228 | 2012-08-14 |
| 1265739122 | Family Preservation Services, Inc. | Community/Behavioral Health | Technology Park Drive, Clintwood, VA 24228 | 2011-02-11 |
| Find all providers in zip 24228 | ||||
| Taxonomy Code | 364SP0809X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health, Adult |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003145152 | Julie Russell | Clinical Nurse Specialist | 5597 Cedar Break Dr, Centreville, VA 20120-3329 | 2009-12-21 |
| 1730412214 | Karen Shatkin Bloomfield | Clinical Nurse Specialist | 1877 Pine Cone Cir, Charlottesville, VA 22901-8932 | 2009-09-15 |
| 1710028030 | Marilyn Augustine Williamson | Clinical Nurse Specialist | 101 Hemlock Ct, Sterling, VA 20164-2115 | 2007-02-09 |
| 1508905647 | Mary Jane Nelson | Clinical Nurse Specialist | 1725 N George Mason Drive, Arlington, VA 22205 | 2007-02-05 |
| 1528169406 | Linda D Grey | Clinical Nurse Specialist | 131 Great Falls St, Suite 101, Falls Church, VA 22046-3445 | 2006-09-26 |
| 1144241662 | Margaret Glenna Doyle | Clinical Nurse Specialist | 54 E Lee St, Warrenton, VA 20186-3325 | 2006-07-21 |
| 1598783946 | Michele L Zimmerman | Clinical Nurse Specialist | 420 N Center Dr Suite 141, Interstate Corporate Center Building 11, Norfolk, VA 23502 | 2006-07-17 |
| 1366448029 | Ellen Christine Redling | Clinical Nurse Specialist | 44355 Premier Plz, Suite 120, Ashburn, VA 20147-5049 | 2005-06-27 |
| 1588945018 | Marion Louise Kyner | Clinical Nurse Specialist | 2003 Cobb St, Farmville, VA 23901-2603 | 2011-08-29 |
| 1922264696 | Patricia Cheeks | Clinical Nurse Specialist | 600 Peter Jefferson Pkwy, Memb-, Charlottesville, VA 22911-8835 | 2008-08-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.