Provider Demographics
NPI:1902280050
Name:JOHNSTON MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:JOHNSTON MEMORIAL HOSPITAL, INC
Other - Org Name:JOHNSTON MEMORIAL HOSPITAL REHABILITATION
Other - Org Type:Doing Business As
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:276-623-0153
Mailing Address - Fax:276-623-1672
Practice Address - Street 1:445 PORTERFIELD HWY SW
Practice Address - Street 2:SUITE F/G
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2556
Practice Address - Country:US
Practice Address - Phone:276-623-0153
Practice Address - Fax:276-623-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1864282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
490053Medicare Oscar/Certification