Provider Demographics
NPI:1669674685
Name:COMMUNITY HEALTH CLINIC, PC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA PROCESSING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-873-6300
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-1020
Mailing Address - Country:US
Mailing Address - Phone:276-873-6300
Mailing Address - Fax:276-873-5859
Practice Address - Street 1:5705 REDBUD HWY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-6300
Practice Address - Fax:276-873-5859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-01
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA282424OtherBC/BS
VACK2829OtherRAILROAD MEDICARE
VACO8032Medicare ID - Type Unspecified