Provider Demographics
NPI:1134343551
Name:FAMILY CARE OF BLACKSBURG
Entity type:Organization
Organization Name:FAMILY CARE OF BLACKSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-951-9444
Mailing Address - Street 1:708 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3634
Mailing Address - Country:US
Mailing Address - Phone:540-951-9444
Mailing Address - Fax:540-951-3270
Practice Address - Street 1:708 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3634
Practice Address - Country:US
Practice Address - Phone:540-951-9444
Practice Address - Fax:540-951-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-07-21
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
VAS68600Medicare UPIN
VAD60981Medicare UPIN