Provider Demographics
NPI:1952823502
Name:ROCKBRIDGE AREA FREE CLINIC
Entity Type:Organization
Organization Name:ROCKBRIDGE AREA FREE CLINIC
Other - Org Name:MOUNTAIN VIEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-464-8700
Mailing Address - Street 1:25 NORTHRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3399
Mailing Address - Country:US
Mailing Address - Phone:540-464-8700
Mailing Address - Fax:
Practice Address - Street 1:2131 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3111
Practice Address - Country:US
Practice Address - Phone:540-464-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty