Provider Demographics
NPI:1558522938
Name:BROCK HUGHES FREE CLINIC, INC.
Entity Type:Organization
Organization Name:BROCK HUGHES FREE CLINIC, INC.
Other - Org Name:BROCK HUGHES MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LINKOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-223-0558
Mailing Address - Street 1:450 WEST MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-223-0558
Mailing Address - Fax:276-223-0015
Practice Address - Street 1:450 WEST MONROE STREET
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-223-0558
Practice Address - Fax:276-223-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No3336C0002XSuppliersPharmacyClinic Pharmacy