Healthcare Provider Details

I. General information

NPI: 1821480658
Provider Name (Legal Business Name): MEMORIAL FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RISON ST STE 120
DANVILLE VA
24541-2426
US

IV. Provider business mailing address

501 RISON ST STE 120
DANVILLE VA
24541-2426
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-3730
  • Fax: 434-792-6048
Mailing address:
  • Phone: 434-792-3730
  • Fax: 434-792-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0101053147
License Number StateVA

VIII. Authorized Official

Name: MRS. LISA DIXON ADKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 434-792-3730