Provider Demographics
NPI:1558652784
Name:WARREN-VANCE COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WARREN-VANCE COMMUNITY HEALTH CENTER, INC.
Other - Org Name:NORTHERN OUTREACH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-492-2161
Mailing Address - Street 1:511 RUIN CREEK RD
Mailing Address - Street 2:105
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5919
Mailing Address - Country:US
Mailing Address - Phone:252-492-2161
Mailing Address - Fax:252-438-2204
Practice Address - Street 1:511 RUIN CREEK RD
Practice Address - Street 2:105
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5919
Practice Address - Country:US
Practice Address - Phone:252-492-2161
Practice Address - Fax:252-438-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1077723261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health