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General NPI Number Information
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NPI Number | 1558653741
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Entity Type | Organization
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Legal Business Name | CLINCH RIVER HEALTH SERVICES INC
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 17285 VETERANS MEMORIAL HWY
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City | DUNGANNON
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State | VA
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Zip | 24245
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Country | US
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Telephone | 276-467-2201
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Fax | 276-467-2673
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Provider Business Mailing Address
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Address Line | PO BOX 4710
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City | GLEN ALLEN
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State | VA
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Zip | 23058-4710
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Country | US
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Telephone | 804-237-7690
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GARY GILLIAM
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Credential |
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Telephone | 276-467-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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