Healthcare Provider Details

I. General information

NPI: 1578858247
Provider Name (Legal Business Name): WARREN COMMUNITY HEALTH CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 W RIDGEWAY ST
WARRENTON NC
27589-1716
US

IV. Provider business mailing address

546 W RIDGEWAY ST
WARRENTON NC
27589-1716
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-1904
  • Fax: 252-257-1142
Mailing address:
  • Phone: 252-257-1904
  • Fax: 252-257-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY JONES SOMERVILLE
Title or Position: EXECUTIVE DIRECTOR
Credential: ETC
Phone: 252-257-1904