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440 Colonial Trail West Dendron VA 23839 | |
(757) 859-6161 | |
(757) 859-6452 |
Full Name | |
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Speciality | Clinic/Center |
Location | 440 Colonial Trail West, Dendron, Virginia |
Authorized Official Name and Position | Cheryl Ebersole (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 7578596161 |
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 210 Ivor VA 23866-0210 Ph: (757) 859-6161 | 440 Colonial Trail West Dendron VA 23839 Ph: (757) 859-6161 |
NPI Number | 1518137389 |
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Provider Enumeration Date | 03/07/2008 |
Last Update Date | 09/12/2019 |
Medicare PECOS PAC ID | 1153232749 |
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Medicare Enrollment ID | O20081120000724 |
Identifier | Type | State | Issuer |
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1518137389 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |