Healthcare Provider Details

I. General information

NPI: 1558653741
Provider Name (Legal Business Name): CLINCH RIVER HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17285 VETERANS MEMORIAL HWY
DUNGANNON VA
24245
US

IV. Provider business mailing address

PO BOX 4710
GLEN ALLEN VA
23058-4710
US

V. Phone/Fax

Practice location:
  • Phone: 276-467-2201
  • Fax: 276-467-2673
Mailing address:
  • Phone: 804-237-7690
  • 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: GARY GILLIAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-467-2201