Provider Demographics
NPI:1154345957
Name:COMMUNITY HEALTH CLINIC PC
Entity type:Organization
Organization Name:COMMUNITY HEALTH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-873-6300
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-1020
Mailing Address - Country:US
Mailing Address - Phone:276-873-6300
Mailing Address - Fax:276-873-5859
Practice Address - Street 1:5705 REDBUD HWY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-873-6300
Practice Address - Fax:276-873-5859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051181261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5800811Medicaid
VAF78295Medicare UPIN
VA5800811Medicaid