Healthcare Provider Details

I. General information

NPI: 1508646571
Provider Name (Legal Business Name): ROCKBRIDGE AREA FREE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 GREENHOUSE RD
LEXINGTON VA
24450-3718
US

IV. Provider business mailing address

25 NORTHRIDGE LN
LEXINGTON VA
24450-3399
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-8700
  • Fax:
Mailing address:
  • Phone: 540-464-8700
  • 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: VALERIE SUZANNE SHERIDAN
Title or Position: CEO
Credential:
Phone: 540-464-8700