Provider Demographics
NPI:1194016915
Name:WARREN-VANCE COMMUINTY HEALTH CENTER
Entity Type:Organization
Organization Name:WARREN-VANCE COMMUINTY HEALTH CENTER
Other - Org Name:NORTHERN OUTREACH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-492-2161
Mailing Address - Street 1:6010A NC HIGHWAY 561
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-8836
Mailing Address - Country:US
Mailing Address - Phone:919-340-0283
Mailing Address - Fax:919-340-0286
Practice Address - Street 1:6010A NC HIGHWAY 561
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-8836
Practice Address - Country:US
Practice Address - Phone:919-340-0283
Practice Address - Fax:919-340-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1077723261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health