Provider Demographics
NPI: | 1518157957 |
---|---|
Name: | SPECIALTY CLINIC |
Entity Type: | Organization |
Organization Name: | SPECIALTY CLINIC |
Other - Org Name: | PCH OPERATIONS, LLC DBA R.J. REYNOLDS-PATRICK COUNTY MEMORIAL HOSPITAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JANICE |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | WILKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 276-694-8678 |
Mailing Address - Street 1: | 18688 JEB STUART HWY |
Mailing Address - Street 2: | |
Mailing Address - City: | STUART |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 24171-1559 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 276-694-3151 |
Mailing Address - Fax: | 276-694-8655 |
Practice Address - Street 1: | 18688 JEB STUART HWY |
Practice Address - Street 2: | |
Practice Address - City: | STUART |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24171-1559 |
Practice Address - Country: | US |
Practice Address - Phone: | 276-694-3151 |
Practice Address - Fax: | 276-694-8655 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-08-01 |
Last Update Date: | 2007-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |