MEDICARE: ST CHARLES HEALTH COUNCIL INC

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	:	1992827604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CHARLES HEALTH COUNCIL INC

Provider Business Mailing Address
First Line	:	4124 COUNCIL MOUNTAIN RD
Second Line	:
City	:	HONAKER
State	:	VA
Zip	:	24260-4994
Country	:	US
Telephone Number	:	276-859-0859
Fax Number	:	276-546-9708

Provider Business Practice Location Address
First Line	:	ROUTE 80
Second Line	:
City	:	DAVENPORT
State	:	VA
Zip	:	24239
Country	:	US
Telephone Number	:	276-859-0859
Fax Number	:	276-859-0587

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MALCOLM PERDUE
Credential	:
Telephone Number	:	276-546-5310

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/21/2021

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Directions to “ST CHARLES HEALTH COUNCIL INC ” Practice Location

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