| The Broad Street Center | |
|
107 S 5th St Richmond VA 23219-3825 | |
| (804) 719-4000 | |
| (804) 783-2514 |
| Full Name | The Broad Street Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 107 S 5th St, Richmond, Virginia |
| Authorized Official Name and Position | Peter Prizio (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8047832505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Broad Street Center 517 W Grace St Richmond VA 23220-4911 Ph: (804) 783-2505 | The Broad Street Center 107 S 5th St Richmond VA 23219-3825 Ph: (804) 719-4000 |
| NPI Number | 1982992608 |
|---|---|
| Provider Enumeration Date | 07/15/2011 |
| Last Update Date | 12/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982992608 | NPI | - | NPPES |
| 1982992608 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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