Healthcare Provider Details

I. General information

NPI: 1750749818
Provider Name (Legal Business Name): PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 ARMORY DR
FRANKLIN VA
23851-2419
US

IV. Provider business mailing address

1033 28TH ST 2ND FLOOR
NEWPORT NEWS VA
23607-4233
US

V. Phone/Fax

Practice location:
  • Phone: 757-304-5570
  • Fax: 757-304-5577
Mailing address:
  • Phone: 757-591-0643
  • Fax: 757-228-1045

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: ANGELA FUTRELL
Title or Position: CEO
Credential:
Phone: 757-591-0643