Provider Demographics
NPI:1003955337
Name:FAMILY HEALTH CARE ASSOCIATES OF SWVA.,PC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE ASSOCIATES OF SWVA.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-889-1297
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-0369
Mailing Address - Country:US
Mailing Address - Phone:276-889-2394
Mailing Address - Fax:276-889-4716
Practice Address - Street 1:143 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4430
Practice Address - Country:US
Practice Address - Phone:276-889-2394
Practice Address - Fax:276-889-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005600588Medicaid
VA005600588Medicaid
VAB05618Medicare UPIN