Provider Demographics
NPI:1629369368
Name:WARREN-VANCE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:WARREN-VANCE COMMUNITY HEALTH CENTER
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 1:816 US 158 BUSINESS WEST
Mailing Address - Street 2:102
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589
Mailing Address - Country:US
Mailing Address - Phone:252-257-6213
Mailing Address - Fax:252-257-3286
Practice Address - Street 1:816 US 158 BUSINESS WEST
Practice Address - Street 2:102
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589
Practice Address - Country:US
Practice Address - Phone:252-257-6213
Practice Address - Fax:252-257-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1077723261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health