Provider Demographics
NPI:1114930732
Name:WASHINGTON SQUARE RHC
Entity Type:Organization
Organization Name:WASHINGTON SQUARE RHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-963-2231
Mailing Address - Street 1:3150 CLINCH ST
Mailing Address - Street 2:P.O. BOX 645
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2172
Mailing Address - Country:US
Mailing Address - Phone:276-964-6711
Mailing Address - Fax:276-964-2240
Practice Address - Street 1:3150 CLINCH ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2172
Practice Address - Country:US
Practice Address - Phone:276-964-6711
Practice Address - Fax:276-964-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610068Medicaid
VA016930OtherANTHEM BCBS
PA493821Medicare Oscar/Certification