MEDICARE: VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER

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)

General Provider Information

NPI Number	:	1336735638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	2809 NORTH AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-3647
Country	:	US
Telephone Number	:	804-780-0840
Fax Number	:	804-329-1206

Provider Business Practice Location Address
First Line	:	5118 RICHMOND HENRICO TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-3627
Country	:	US
Telephone Number	:	804-780-0840
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TRACY CAUSEY
Credential	:
Telephone Number	:	804-253-1968

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	11/17/2022

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