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100 Main Street St. Charles VA 24282 | |
(276) 383-4428 | |
(276) 383-4927 |
Full Name | |
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Speciality | Clinic/Center |
Location | 100 Main Street, St. Charles, 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 |
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241 Monarch Rd Saint Charles VA 24282-8122 Ph: (276) 383-4428 | 100 Main Street St. Charles VA 24282 Ph: (276) 383-4428 |
NPI Number | 1144342270 |
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Provider Enumeration Date | 04/06/2007 |
Last Update Date | 07/21/2021 |
Medicare PECOS PAC ID | 0244124584 |
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Medicare Enrollment ID | O20100719000928 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144342270 | NPI | - | NPPES |
007601867 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |