Healthcare Provider Details

I. General information

NPI: 1487089512
Provider Name (Legal Business Name): LLOYD F. MOSS FREE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SAM PERRY BLVD
FREDERICKSBURG VA
22401-8420
US

IV. Provider business mailing address

1301 SAM PERRY BLVD
FREDERICKSBURG VA
22401-8420
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1061
  • Fax: 540-741-1096
Mailing address:
  • Phone: 540-741-1061
  • Fax: 540-741-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0024105931
License Number StateVA

VIII. Authorized Official

Name: MS. KAREN DULANEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-741-1061