Healthcare Provider Details

I. General information

NPI: 1255319661
Provider Name (Legal Business Name): BOYDTON COMMUNITY HEALTH FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 WASHINGTON STREET
BOYDTON VA
23917-0540
US

IV. Provider business mailing address

P.O. BOX 540
BOYDTON VA
23917-0540
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-6102
  • Fax: 434-738-6982
Mailing address:
  • Phone: 434-738-6102
  • Fax: 434-738-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA N MILLER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 434-738-6102