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General NPI Number Information
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NPI Number | 1689875312
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Entity Type | Organization
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Legal Business Name | FREE CLINIC OF DANVILLE
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 S RIDGE ST
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City | DANVILLE
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State | VA
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Zip | 24541-1313
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Country | US
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Telephone | 434-799-1223
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Fax | 434-799-6737
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Provider Business Mailing Address
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Address Line | 133 S RIDGE ST
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City | DANVILLE
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State | VA
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Zip | 24541-1313
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Country | US
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Telephone | 434-799-1223
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Fax | 434-799-6737
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EDWIN J HARVIE JR.
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Credential | MD
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Telephone | 434-799-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101013597
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License Number State | VA
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