Provider Demographics
NPI:1962532218
Name:CLINCH VALLEY FAMILY PODIATRY, PLLC
Entity type:Organization
Organization Name:CLINCH VALLEY FAMILY PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:276-964-2411
Mailing Address - Street 1:6719 GOVERNOR G.C. PEERY HWY
Mailing Address - Street 2:SUITE 3800
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-596-9346
Mailing Address - Fax:276-596-9348
Practice Address - Street 1:6719 GOVERNOR G.C. PEERY HWY
Practice Address - Street 2:SUITE 3800
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-596-9346
Practice Address - Fax:276-596-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300952213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962532218Medicaid
WV3810006139Medicaid
VAV10656Medicare UPIN
WV3810006139Medicaid
VAC10106Medicare PIN
VA5891250001Medicare NSC