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2256 Irish Rd Esmont VA 22937-1945 | |
(434) 286-3602 | |
(434) 286-3819 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2256 Irish Rd, Esmont, Virginia |
Authorized Official Name and Position | Charles Allbaugh (CFO) |
Authorized Official Contact | 4345814073 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 220 New Canton VA 23123-0220 Ph: (434) 581-4073 | 2256 Irish Rd Esmont VA 22937-1945 Ph: (434) 286-3602 |
NPI Number | 1588792162 |
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Provider Enumeration Date | 03/02/2007 |
Last Update Date | 12/16/2019 |
Medicare PECOS PAC ID | 0345158432 |
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Medicare Enrollment ID | O20030321000012 |
Identifier | Type | State | Issuer |
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1588792162 | NPI | - | NPPES |
007600151 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |