Provider Demographics
NPI:1184051575
Name:GLOUCESTER MATHEWS CARE CLINIC
Entity type:Organization
Organization Name:GLOUCESTER MATHEWS CARE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMENTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-210-1368
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-0684
Mailing Address - Country:US
Mailing Address - Phone:804-210-1368
Mailing Address - Fax:804-210-1369
Practice Address - Street 1:6031 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3767
Practice Address - Country:US
Practice Address - Phone:804-210-1368
Practice Address - Fax:804-210-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center