Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 10279 Hurley Road, Hurley, Virginia |
Authorized Official Name and Position | Malcolm Perdue (CEO) |
Authorized Official Contact | 2765465310 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
276 Fieldstone Dr Jonesville VA 24263-1215 Ph: (276) 546-5310 | 10279 Hurley Road Hurley VA 24620 Ph: (276) 566-7204 |
NPI Number | 1801060595 |
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Provider Enumeration Date | 04/15/2008 |
Last Update Date | 07/21/2021 |
Medicare PECOS PAC ID | 0244124584 |
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Medicare Enrollment ID | O20080423000413 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801060595 | NPI | - | NPPES |
1801060595 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |