Healthcare Provider Details

I. General information

NPI: 1639799166
Provider Name (Legal Business Name): WHITE OAK PRIMARY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N MAIN ST
HALIFAX VA
24558-2995
US

IV. Provider business mailing address

235 N MAIN ST
HALIFAX VA
24558-2995
US

V. Phone/Fax

Practice location:
  • Phone: 434-830-2605
  • Fax: 434-830-2258
Mailing address:
  • Phone: 434-830-2605
  • Fax: 434-830-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SHANNON N SCEARCE
Title or Position: OWNER/PRESIDENT/PROVIDER
Credential: DNP, FNP-C
Phone: 434-830-2605