Provider Demographics
NPI:1487723086
Name:NEW RIVER INTERNAL MEDICINE INC
Entity type:Organization
Organization Name:NEW RIVER INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WEIDNER
Authorized Official - Last Name:KNARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-980-8804
Mailing Address - Street 1:2460 LEE HWY N
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-2335
Mailing Address - Country:US
Mailing Address - Phone:540-980-8804
Mailing Address - Fax:540-980-8161
Practice Address - Street 1:2460 LEE HWY N
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2335
Practice Address - Country:US
Practice Address - Phone:540-980-8804
Practice Address - Fax:540-980-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01505Medicare ID - Type Unspecified