| Stone Mountain Health Services | |
|
2534 Mendota Road Mendota VA 24270 | |
| (276) 645-6710 | |
| Not Available |
| Full Name | Stone Mountain Health Services |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2534 Mendota Road, Mendota, Virginia |
| Authorized Official Name and Position | Malcolm Perdue (CEO) |
| Authorized Official Contact | 2765465310 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stone Mountain Health Services 2534 Mendota Road Mendota VA 24270 Ph: (276) 645-6710 | Stone Mountain Health Services 2534 Mendota Road Mendota VA 24270 Ph: (276) 645-6710 |
| NPI Number | 1114047016 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 09/04/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114047016 | NPI | - | NPPES |
| 1114047016 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mendota Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2534 Mendota Rd, Mendota, VA 24270 Phone: 276-645-6710 Fax: 276-645-6712 |