Provider Demographics
NPI:1043648611
Name:FREE CLINIC OF THE NEW RIVER VALLEY INC
Entity Type:Organization
Organization Name:FREE CLINIC OF THE NEW RIVER VALLEY INC
Other - Org Name:MONTGOMERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-381-0820
Mailing Address - Street 1:215 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3025
Mailing Address - Country:US
Mailing Address - Phone:540-381-0820
Mailing Address - Fax:540-382-3391
Practice Address - Street 1:215 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3025
Practice Address - Country:US
Practice Address - Phone:540-381-0820
Practice Address - Fax:540-382-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)