Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 20306 Badger Lane, Onley, Virginia |
Authorized Official Name and Position | Jeannette Edwards (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 7574140400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
20280 Market St Onancock VA 23417-1331 Ph: (757) 414-0400 | 20306 Badger Lane Onley VA 23418 Ph: (757) 787-7374 |
NPI Number | 1568592426 |
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Provider Enumeration Date | 03/07/2007 |
Last Update Date | 03/22/2023 |
Medicare PECOS PAC ID | 2668380106 |
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Medicare Enrollment ID | O20051122000014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568592426 | NPI | - | NPPES |
007600011 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |