Healthcare Provider Details

I. General information

NPI: 1629109806
Provider Name (Legal Business Name): LOUDOUN COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 FORT EVANS ROAD NE
LEESBURG VA
20176-4420
US

IV. Provider business mailing address

163 FORT EVANS ROAD, NE
LEESBURG VA
20176-4420
US

V. Phone/Fax

Practice location:
  • Phone: 703-443-2000
  • Fax: 703-443-2033
Mailing address:
  • Phone: 703-840-4707
  • Fax: 703-771-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateVA

VIII. Authorized Official

Name: AMANDEEP DHINDSA
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 703-840-4707