| Complete Whole & Compassionate Care Cwc | |
|
1700 Huguenot Rd Ste 2b Midlothian VA 23113-2397 | |
| (804) 641-7816 | |
| Not Available |
| Full Name | Complete Whole & Compassionate Care Cwc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 Huguenot Rd Ste 2b, Midlothian, Virginia |
| Authorized Official Name and Position | Marshall Romona Wigfall (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 8045946837 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Complete Whole & Compassionate Care Cwc 1700 Huguenot Rd Ste E Midlothian VA 23113-2397 Ph: (804) 594-6837 | Complete Whole & Compassionate Care Cwc 1700 Huguenot Rd Ste 2b Midlothian VA 23113-2397 Ph: (804) 641-7816 |
| NPI Number | 1356967103 |
|---|---|
| Provider Enumeration Date | 06/17/2020 |
| Last Update Date | 05/24/2021 |
| Certification Date | 05/24/2021 |
| Medicare PECOS PAC ID | 2466862206 |
|---|---|
| Medicare Enrollment ID | O20201105000897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356967103 | NPI | - | NPPES |
| 1629306139 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Marshall Romona Wigfall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629306139 PECOS PAC ID: 0547403412 Enrollment ID: I20130823001199 |
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