Healthcare Provider Details

I. General information

NPI: 1891990099
Provider Name (Legal Business Name): FREE MEDICAL CLINIC OF MARTINSVILLE & HENRY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR SUITE 203
MARTINSVILLE VA
24112-1945
US

IV. Provider business mailing address

PO BOX 3231
MARTINSVILLE VA
24115-3231
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-0787
  • Fax: 276-638-2430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A. JACKMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-638-2523