|
| |
|
4714 Marshall Avenue Newport News VA 23607 | |
| (757) 380-8709 | |
| (757) 928-0902 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4714 Marshall Avenue, Newport News, Virginia |
| Authorized Official Name and Position | Angela Futrell (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7573808709 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1033 28th St 2nd Floor Newport News VA 23607-4233 Ph: (757) 591-0643 | 4714 Marshall Avenue Newport News VA 23607 Ph: (757) 380-8709 |
| NPI Number | 1508999293 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 04/01/2008 |
| Medicare PECOS PAC ID | 9234040148 |
|---|---|
| Medicare Enrollment ID | O20030715000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508999293 | NPI | - | NPPES |
| 7687648 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Peninsula Institute For Community Health Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1033 28th St, 2nd Floor, Newport News, VA 23607 Phone: 757-591-0643 Fax: 757-591-0682 | |
Riverside Hospital Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 856 J Clyde Morris Blvd, Suite A, Newport News, VA 23601 Phone: 757-594-4006 Fax: 757-534-5190 | |