Provider Demographics
NPI:1568838738
Name:GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC
Other - Org Name:GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER DUMFRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-680-7950
Mailing Address - Street 1:PO BOX 3929
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-3929
Mailing Address - Country:US
Mailing Address - Phone:703-680-7950
Mailing Address - Fax:703-680-7953
Practice Address - Street 1:17739 MAIN ST
Practice Address - Street 2:130
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-3251
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:703-680-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)