MEDICARE: MARTINSVILLE HENRY COUNTY COALITION FOR HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063608081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTINSVILLE HENRY COUNTY COALITION FOR HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	29 JONES ST
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-2716
Country	:	US
Telephone Number	:	276-638-0787
Fax Number	:	276-403-4353

Provider Business Practice Location Address
First Line	:	324 T B STANLEY HWY
Second Line	:	STE B AND C
City	:	BASSETT
State	:	VA
Zip	:	24055-6108
Country	:	US
Telephone Number	:	276-638-0787
Fax Number	:	276-629-2695

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	GINA FINOCCHIARO
Credential	:
Telephone Number	:	276-403-5096

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	10/16/2024

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