Healthcare Provider Details

I. General information

NPI: 1558522938
Provider Name (Legal Business Name): BROCK HUGHES FREE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W MONROE ST
WYTHEVILLE VA
24382-2236
US

IV. Provider business mailing address

450 W MONROE ST
WYTHEVILLE VA
24382-2236
US

V. Phone/Fax

Practice location:
  • Phone: 276-223-0558
  • Fax: 276-223-0015
Mailing address:
  • Phone: 276-223-0558
  • Fax: 276-223-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY RENEE LINKOUS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-223-0558