Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 102 Oquinn Drive, Haysi, Virginia |
Authorized Official Name and Position | Malcom Perdue (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2768655121 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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102 Oquinn Drive Haysi VA 24256 Ph: (276) 865-5121 | 102 Oquinn Drive Haysi VA 24256 Ph: (276) 865-5121 |
NPI Number | 1952423667 |
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Provider Enumeration Date | 04/04/2007 |
Last Update Date | 08/24/2007 |
Medicare PECOS PAC ID | 0244124584 |
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Medicare Enrollment ID | O20100607000204 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952423667 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |