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1329 Jefferson Street Boydton VA 23917 | |
(434) 738-0729 | |
(434) 738-6982 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1329 Jefferson Street, Boydton, Virginia |
Authorized Official Name and Position | Angela N Miller (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 4347386102 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 540 Boydton VA 23917-0540 Ph: (434) 738-6102 | 1329 Jefferson Street Boydton VA 23917 Ph: (434) 738-0729 |
NPI Number | 1114184546 |
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Provider Enumeration Date | 05/22/2008 |
Last Update Date | 07/24/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114184546 | NPI | - | NPPES |
007691092 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mecklenburg Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 969 Madison St, Boydton, VA 23917 Phone: 434-738-6911 Fax: 434-738-0431 | |