Organization Name: | BLAND COUNTY MEDICAL CLINIC, INC. |
NPI Number: | 1104800671 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN GREEVER (EXECUTIVE DIRECTOR) |
Mailing Address: | 12301 Grapefield Rd Bastian |
State: | VA US |
Postal Code: | 243144547 |
Phone Number: | 2766884331 |
Fax Number: | 2766884336 |
NPI Enumeration Date: | 11/30/2005 |
NPI Last Update Date: | 08/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |