| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 176 Junction Dr, Ashland, Virginia |
| Authorized Official Name and Position | Tracy Causey (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8042531968 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2809 North Ave Richmond VA 23222-3647 Ph: (804) 780-0840 | 176 Junction Dr Ashland VA 23005 Ph: (804) 780-0840 |
| NPI Number | 1528491594 |
|---|---|
| Provider Enumeration Date | 08/14/2013 |
| Last Update Date | 07/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528491594 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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