Provider Demographics
NPI:1336221407
Name:RADFORD UNIVERSITY
Entity Type:Organization
Organization Name:RADFORD UNIVERSITY
Other - Org Name:RADFORD UNIVERSITY FAMILY HEALTH CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-831-7662
Mailing Address - Street 1:PO BOX 7020
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24142-7020
Mailing Address - Country:US
Mailing Address - Phone:540-831-7660
Mailing Address - Fax:540-831-7740
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:WALDRON HALL FIRST FLOOR
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24142-0001
Practice Address - Country:US
Practice Address - Phone:540-831-7660
Practice Address - Fax:540-831-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN