Provider Demographics
NPI:1255319661
Name:BOYDTON COMMUNITY HEALTH FACILITY, INC.
Entity Type:Organization
Organization Name:BOYDTON COMMUNITY HEALTH FACILITY, INC.
Other - Org Name:HEALTHCARE ON THE SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-738-6102
Mailing Address - Street 1:P.O. BOX 540
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-0540
Mailing Address - Country:US
Mailing Address - Phone:434-738-6102
Mailing Address - Fax:434-738-6982
Practice Address - Street 1:380 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917-0540
Practice Address - Country:US
Practice Address - Phone:434-738-6102
Practice Address - Fax:434-738-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007691092Medicaid
VA491869Medicare PIN
VAC01682Medicare PIN
VA491800Medicare Oscar/Certification