Healthcare Provider Details

I. General information

NPI: 1750592788
Provider Name (Legal Business Name): FREE MEDICAL CLINIC OF NORTHERN SHENANDOAH VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N CAMERON ST SUITE 100
WINCHESTER VA
22601-4899
US

IV. Provider business mailing address

301 N CAMERON ST SUITE 100
WINCHESTER VA
22601-4899
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-1680
  • Fax: 540-662-4724
Mailing address:
  • Phone: 540-536-1680
  • Fax: 540-662-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0201002404
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN W. ARCHIBALD
Title or Position: PHARMACIST IN CHARGE
Credential: R.PH
Phone: 540-536-1680