Provider Demographics
NPI:1689875312
Name:FREE CLINIC OF DANVILLE
Entity Type:Organization
Organization Name:FREE CLINIC OF DANVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARVIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-799-1123
Mailing Address - Street 1:133 S RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1313
Mailing Address - Country:US
Mailing Address - Phone:434-799-1223
Mailing Address - Fax:434-799-6737
Practice Address - Street 1:133 S RIDGE ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1313
Practice Address - Country:US
Practice Address - Phone:434-799-1223
Practice Address - Fax:434-799-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101013597261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care