Provider Demographics
NPI:1891885273
Name:FAMILY HEALTH CARE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE ASSOCIATES
Other - Org Name:RIDGEWOOD HEALTH CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-889-2394
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-0369
Mailing Address - Country:US
Mailing Address - Phone:276-889-2394
Mailing Address - Fax:276-889-3861
Practice Address - Street 1:143 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4214
Practice Address - Country:US
Practice Address - Phone:276-889-2394
Practice Address - Fax:276-889-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7617917Medicaid
VA7617917Medicaid