Provider Demographics
NPI:1861733669
Name:THE FREE CLINIC OF ROCKINGHAM COUNTY, INC
Entity type:Organization
Organization Name:THE FREE CLINIC OF ROCKINGHAM COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:GARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-349-3220
Mailing Address - Street 1:314 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320
Mailing Address - Country:US
Mailing Address - Phone:336-349-3220
Mailing Address - Fax:336-349-3229
Practice Address - Street 1:315 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320
Practice Address - Country:US
Practice Address - Phone:336-349-3220
Practice Address - Fax:336-349-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care