Provider Demographics
NPI:1467998443
Name:SCFM CONVENIENCE CLINIC, PLLC
Entity Type:Organization
Organization Name:SCFM CONVENIENCE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-868-4100
Mailing Address - Street 1:160 WARRIOR DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-4044
Mailing Address - Country:US
Mailing Address - Phone:540-868-4100
Mailing Address - Fax:540-868-0888
Practice Address - Street 1:160 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-4044
Practice Address - Country:US
Practice Address - Phone:540-868-4100
Practice Address - Fax:540-868-0888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENS CITY FAMILY MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty