Basic Information
| Provider Information | |||||||||
| NPI: | 1922182286 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NCH RESIDENCY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 15TH ST NW | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242731620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766798890 | ||||||||
| FaxNumber: | 2766799740 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 SPRING AVE NE | ||||||||
| Address2: | WISE PROFESSIONAL OFFICE BLDG | ||||||||
| City: | WISE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242935702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763283394 | ||||||||
| FaxNumber: | 2763283396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | STURGILL | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER, CPSC | ||||||||
| AuthorizedOfficialTelephone: | 2766798890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.