| Federal Bureau Prisons, Fcc Petersburg | |
|
1060 River Rd Petersburg VA 23801-1398 | |
| (804) 504-7200 | |
| (804) 504-7225 |
| Full Name | Federal Bureau Prisons, Fcc Petersburg |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1060 River Rd, Petersburg, Virginia |
| Authorized Official Name and Position | Abdelouahab Benmansour (HSA) |
| Authorized Official Contact | 8045047200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Federal Bureau Prisons, Fcc Petersburg Po Box 90026 Petersburg VA 23804-9000 Ph: (804) 504-7200 | Federal Bureau Prisons, Fcc Petersburg 1060 River Rd Petersburg VA 23801-1398 Ph: (804) 504-7200 |
| NPI Number | 1700154978 |
|---|---|
| Provider Enumeration Date | 12/02/2011 |
| Last Update Date | 04/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700154978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | MD052885L (Pennsylvania) | Primary |
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