VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER (GLENWOOD MEDICAL CENTER) - NPI NUMBER 1396078135

Summary

Provider Name: VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER (GLENWOOD MEDICAL CENTER)

NPI Number: 1396078135

Clasification: Clinic/Center (261QF0400X)

Specialization: Federally Qualified Health Center (FQHC)

Address:
2711 BYRON ST
RICHMOND, VA
ZIP 23223

Phone Number: (804) 525-1818



Detailed Information

VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER is a federally qualified health center (fqhc) clinic/center in Richmond, VA. The assigned NPI number for this provider is 1396078135 and is registered as an organization entity type.
The provider Is Doing Business As Glenwood Medical Center.

The provider's business address is:

2711 BYRON ST
RICHMOND, VA
ZIP 23223-313
Phone: (804) 525-1818
Fax: (804) 525-1820

The provider's authorized official is Tracy Causey .
The authorized official title is Executive Director and has the following contact phone number (804) 591-2890.

The enumeration date for this NPI number is 9/11/2009 and was last updated on 12/4/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 C06017 MEDICARE PIN VA
2 1396078135 MEDICAID VA
3 491900 MEDICARE OSCAR/CERTIFICATION VA

NPI Record

No. Field Name Field Value
1 NPI 1396078135
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
5 Provider Other Organization Name GLENWOOD MEDICAL CENTER
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 2711 BYRON ST
8 Provider Business Practice Location Address City Name RICHMOND
9 Provider Business Practice Location Address State Name VA
10 Provider Business Practice Location Address Postal Code 232231313
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 8045251818
13 Provider Business Practice Location Address Fax Number 8045251820
14 Provider Enumeration Date 9/11/2009
15 Last Update Date 12/4/2012
16 Authorized Official Last Name CAUSEY
17 Authorized Official First Name TRACY
18 Authorized Official Title or Position EXECUTIVE DIRECTOR
19 Authorized Official Telephone Number 8045912890
20 Healthcare Provider Taxonomy Code 1 261QF0400X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 C06017
23 Other Provider Identifier Type Code 1 08
24 Other Provider Identifier State 1 VA
25 Other Provider Identifier 2 1396078135
26 Other Provider Identifier Type Code 2 05
27 Other Provider Identifier State 2 VA
28 Other Provider Identifier 3 491900
29 Other Provider Identifier Type Code 3 06
30 Other Provider Identifier State 3 VA
31 Is Organization Subpart N

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.