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344 West Main Street Waverly VA 23890 | |
(804) 834-8871 | |
(804) 834-8875 |
Full Name | |
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Speciality | Clinic/Center |
Location | 344 West Main Street, Waverly, Virginia |
Authorized Official Name and Position | Cheryl Ebersole (ADMINISTRATOR) |
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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344 West Main Street Waverly VA 23890 Ph: (804) 834-8871 | 344 West Main Street Waverly VA 23890 Ph: (804) 834-8871 |
NPI Number | 1053538421 |
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Provider Enumeration Date | 04/19/2007 |
Last Update Date | 08/24/2007 |
Medicare PECOS PAC ID | 1153232749 |
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Medicare Enrollment ID | O20030820000036 |
Identifier | Type | State | Issuer |
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1053538421 | NPI | - | NPPES |
007600429 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |