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109 Clearview Rd Madison Heights VA 24572 | |
(434) 455-2480 | |
(434) 455-2487 |
Full Name | |
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Speciality | Clinic/Center |
Location | 109 Clearview Rd, Madison Heights, Virginia |
Authorized Official Name and Position | Gary Campbell (CEO) |
Authorized Official Contact | 4344552480 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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134 Elon Rd Madison Heights VA 24572-2536 Ph: (434) 455-2480 | 109 Clearview Rd Madison Heights VA 24572 Ph: (434) 455-2480 |
NPI Number | 1972858660 |
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Provider Enumeration Date | 07/18/2012 |
Last Update Date | 06/07/2024 |
Medicare PECOS PAC ID | 9537060413 |
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Medicare Enrollment ID | O20120814000534 |
Identifier | Type | State | Issuer |
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1972858660 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Tamara J Tinnin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528442399 PECOS PAC ID: 9830464544 Enrollment ID: I20171005002684 |