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General NPI Number Information
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NPI Number | 1437275377
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE FAMILY CARE CENTER, PC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 217 S INDEPENDENCE AVE
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City | INDEPENDENCE
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State | VA
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Zip | 24348-2802
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Country | US
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Telephone | 276-773-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 217 S INDEPENDENCE AVE
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City | INDEPENDENCE
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State | VA
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Zip | 24348-2802
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Country | US
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Telephone | 276-773-2111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCE LOVELACE
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Credential | DO
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Telephone | 276-773-2111
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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 | VA
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