Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 16431 Wise St, St Paul, Virginia |
Authorized Official Name and Position | Juanita Harwood (DIRECTOR) |
Authorized Official Contact | 4233926565 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1021 W Oakland Ave Ste 310 Johnson City TN 37604-2192 Ph: (423) 302-6567 | 16431 Wise St St Paul VA 24283 Ph: (276) 762-2300 |
NPI Number | 1386813616 |
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Provider Enumeration Date | 02/20/2008 |
Last Update Date | 08/12/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386813616 | NPI | - | NPPES |
020157701 | Other | VI | DEPARTMENT OF LABOR |
1386813616 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |