Provider Demographics
NPI:1396496063
Name:BLAND COUNTY MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:BLAND COUNTY MEDICAL CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & ENROLLMENT/OUTREACH
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-688-4331
Mailing Address - Street 1:12301 GRAPEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BASTIAN
Mailing Address - State:VA
Mailing Address - Zip Code:24314-4547
Mailing Address - Country:US
Mailing Address - Phone:276-688-4331
Mailing Address - Fax:276-688-4336
Practice Address - Street 1:8494 S SCENIC HWY
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315-5255
Practice Address - Country:US
Practice Address - Phone:276-688-0500
Practice Address - Fax:276-688-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)