Provider Demographics
NPI:1023056926
Name:TWIN COUNTY FAMILY CARE CENTERS INC
Entity type:Organization
Organization Name:TWIN COUNTY FAMILY CARE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:APPLEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-236-1650
Mailing Address - Street 1:106 DOCTORS PARK
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2276
Mailing Address - Country:US
Mailing Address - Phone:276-236-1650
Mailing Address - Fax:276-236-1715
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2227
Practice Address - Country:US
Practice Address - Phone:276-236-1650
Practice Address - Fax:276-236-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010392811Medicaid
VA010392811Medicaid
C04388Medicare PIN