Provider Demographics
NPI:1912537440
Name:B'S INTEGRATED CLINIC, PLLC
Entity Type:Organization
Organization Name:B'S INTEGRATED CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE-FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:434-251-9210
Mailing Address - Street 1:1291 S BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5032
Mailing Address - Country:US
Mailing Address - Phone:434-251-9210
Mailing Address - Fax:434-421-6416
Practice Address - Street 1:1291 S BOSTON RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5032
Practice Address - Country:US
Practice Address - Phone:434-251-9210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center