Provider Demographics
NPI:1477751915
Name:ELKTON FAMILY AND CHILDRENS MEDICAL CLINIC
Entity Type:Organization
Organization Name:ELKTON FAMILY AND CHILDRENS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GRAYSON
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:540-298-9900
Mailing Address - Street 1:115 E ROCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827-1522
Mailing Address - Country:US
Mailing Address - Phone:540-298-9900
Mailing Address - Fax:540-298-8991
Practice Address - Street 1:115 E ROCKINGHAM ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1522
Practice Address - Country:US
Practice Address - Phone:540-298-9900
Practice Address - Fax:540-298-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166329251V00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010119146Medicaid
VA1134126626OtherINDIVIDUAL NPI NUMBER
VA1477751915OtherEFCMC NPI
VA5689660Medicaid
VAC10418OtherPTAN
VA0101031417OtherDR STAUFFER'S VA LICENSE
VA1538190434OtherDR. STAUFFER NPI
VA1477751915OtherEFCMC NPI
VA1134126626OtherINDIVIDUAL NPI NUMBER
VABO5356Medicare UPIN