| Fatade Health And Medical Center | |
|
255 Riverside Dr Bassett VA 24055-4299 | |
| (276) 627-8070 | |
| (276) 627-8069 |
| Full Name | Fatade Health And Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 255 Riverside Dr, Bassett, Virginia |
| Authorized Official Name and Position | Ayokunle Omotade Fatade (PRESIDENT) |
| Authorized Official Contact | 8566278070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fatade Health And Medical Center 255 Riverside Dr Bassett VA 24055-4299 Ph: (276) 627-8070 | Fatade Health And Medical Center 255 Riverside Dr Bassett VA 24055-4299 Ph: (276) 627-8070 |
| NPI Number | 1598883738 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4385748250 |
|---|---|
| Medicare Enrollment ID | O20070402000710 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598883738 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0102201991 (Virginia) | Primary |
| Provider Name | Ayokunle Omotade Fatade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518993120 PECOS PAC ID: 2365449923 Enrollment ID: I20070402000723 |
Bassett Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 324 T B Stanley Hwy, Ste B And C, Bassett, VA 24055 Phone: 276-638-0787 Fax: 276-629-2695 |