Provider Demographics
NPI:1215110895
Name:TWIN COUNTY REGIONAL HEALTHCARE, INC
Entity type:Organization
Organization Name:TWIN COUNTY REGIONAL HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:276-236-1620
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2227
Mailing Address - Country:US
Mailing Address - Phone:276-238-3502
Mailing Address - Fax:276-236-1715
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2227
Practice Address - Country:US
Practice Address - Phone:276-238-3502
Practice Address - Fax:276-236-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00521Medicare PIN