Provider Demographics
NPI:1043883143
Name:PROVERBS MEDICAL AND HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:PROVERBS MEDICAL AND HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/APMHCNS
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:571-314-6136
Mailing Address - Street 1:1128 LOCKETT DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4050
Mailing Address - Country:US
Mailing Address - Phone:434-203-2593
Mailing Address - Fax:
Practice Address - Street 1:505 ARNETT BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2519
Practice Address - Country:US
Practice Address - Phone:571-314-6136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty