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General NPI Number Information
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NPI Number | 1912537440
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Entity Type | Organization
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Legal Business Name | B'S INTEGRATED CLINIC, PLLC
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 1291 S BOSTON RD
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City | DANVILLE
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State | VA
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Zip | 24540-5032
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Country | US
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Telephone | 434-251-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 1291 S BOSTON RD
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City | DANVILLE
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State | VA
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Zip | 24540-5032
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Country | US
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Telephone | 434-251-9210
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Fax | 434-421-6416
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Authorized Official
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Title or Position | NP-C
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Name | MARILYN WADE-FOSTER
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Credential | NP-C
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Telephone | 434-251-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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