Basic Information
| Provider Information | |||||||||
| NPI: | 1023056926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TWIN COUNTY FAMILY CARE CENTERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 DOCTORS PARK | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | GALAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243332276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762361650 | ||||||||
| FaxNumber: | 2762361715 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GALAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243332227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762361650 | ||||||||
| FaxNumber: | 2762361715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | APPLEBAUM | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2762361650 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | VA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 010392811 | 05 | VA | MEDICAID |