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13855 Courthouse Rd Dinwiddie VA 23841-2254 | |
(804) 469-3731 | |
(804) 469-5307 |
Full Name | |
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Speciality | Clinic/Center |
Location | 13855 Courthouse Rd, Dinwiddie, Virginia |
Authorized Official Name and Position | April King (CEO) |
Authorized Official Contact | 4346962165 |
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 70 Victoria VA 23974-0070 Ph: (434) 696-2165 | 13855 Courthouse Rd Dinwiddie VA 23841-2254 Ph: (804) 469-3731 |
NPI Number | 1487867206 |
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Provider Enumeration Date | 05/08/2007 |
Last Update Date | 02/07/2024 |
Medicare PECOS PAC ID | 0648188755 |
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Medicare Enrollment ID | O20080110000518 |
Identifier | Type | State | Issuer |
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1487867206 | NPI | - | NPPES |
007604025 | Medicaid | VA |