Provider Demographics
NPI:1508943507
Name:WASHINGTON SQUARE CLINIC INC
Entity Type:Organization
Organization Name:WASHINGTON SQUARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT WASHINGTON SQUARE CLINIC
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:276-964-6711
Mailing Address - Street 1:3150 CLINCH ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
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
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:2006-11-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
049118OtherBLUE CROSS BLUE SHIELD
049120OtherBLUE CROSS BLUE SHIELD
068119OtherBLUE CROSS BLUE SHIELD
VA007330146Medicaid
VA049115OtherBCBS
068118OtherBLUE CROSS BLUE SHIELD
1499361OtherUMWA
CG0014OtherRAILROAD MEDICARE GROUP
137286OtherBLUE CROSS BLUE SHIELD
5545395OtherAETNA
001709083OtherMTN STATE BC
VA006034951Medicaid
027996700OtherFEDERAL BLACK LUNG
1499361OtherUMWA
009380W17Medicare ID - Type UnspecifiedRAVI K TITHA MD
VA007330146Medicaid
VA006034951Medicaid
001709083OtherMTN STATE BC
020000579Medicare ID - Type UnspecifiedSTEVEN R HOEBELHEINRICH
VAC02117Medicare PIN