Healthcare Provider Details

I. General information

NPI: 1548706609
Provider Name (Legal Business Name): FREE CLINIC OF THE NEW RIVER VALLEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5826 RUEBUSH RD
DUBLIN VA
24084-2252
US

IV. Provider business mailing address

5826 RUEBUSH RD
DUBLIN VA
24084-2252
US

V. Phone/Fax

Practice location:
  • Phone: 540-381-0820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MICHELLE BRAUNS
Title or Position: CEO
Credential:
Phone: 540-381-0820