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9950 Courthouse Rd Charles City VA 23030-3434 | |
(804) 829-6600 | |
(804) 829-6182 |
Full Name | |
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Speciality | Clinic/Center |
Location | 9950 Courthouse Rd, Charles City, Virginia |
Authorized Official Name and Position | Charles Allbaugh (CFO) |
Authorized Official Contact | 4345814073 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 220 New Canton VA 23123-0220 Ph: (434) 581-4073 | 9950 Courthouse Rd Charles City VA 23030-3434 Ph: (804) 829-6600 |
NPI Number | 1518095280 |
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Provider Enumeration Date | 03/02/2007 |
Last Update Date | 12/16/2019 |
Medicare PECOS PAC ID | 0345158432 |
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Medicare Enrollment ID | O20100629000007 |
Identifier | Type | State | Issuer |
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1518095280 | NPI | - | NPPES |
007604343 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |