Provider Demographics
NPI:1285685727
Name:DICKENSON COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:DICKENSON COMMUNITY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-3467
Mailing Address - Street 1:311 PRINCETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2026
Mailing Address - Country:US
Mailing Address - Phone:276-926-0300
Mailing Address - Fax:276-926-0329
Practice Address - Street 1:312 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-6786
Practice Address - Country:US
Practice Address - Phone:276-926-0300
Practice Address - Fax:276-926-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1918282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010038146Medicaid
A24228 00OtherJOHN DEERE
VA102340OtherANTHEM BLUE CROSS
KY01601087Medicaid
VAC09011Medicare Oscar/Certification
A24228 00OtherJOHN DEERE
A24228 00OtherJOHN DEERE