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General NPI Number Information
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NPI Number | 1255291472
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Entity Type | Organization
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Legal Business Name | ULTRA HEALTH POUNDING MILL
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 13401 GOVERNOR G C PEERY HWY
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City | POUNDING MILL
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State | VA
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Zip | 24637-4010
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Country | US
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Telephone | 276-385-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 13401 GOVERNOR G C PEERY HWY
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City | POUNDING MILL
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State | VA
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Zip | 24637-4010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AO
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Name | KAYLA BRIANA CLINE
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Credential |
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Telephone | 276-385-1183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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