| Loudoun Community Health Center | |
|
11484 Washington Plz W Ste 300 Reston VA 20190-4342 | |
| (703) 443-2000 | |
| Not Available |
| Full Name | Loudoun Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 11484 Washington Plz W Ste 300, Reston, Virginia |
| Authorized Official Name and Position | Robine K Hardey (CFO) |
| Authorized Official Contact | 7034432000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loudoun Community Health Center 163 Fort Evans Rd Ne Leesburg VA 20176-4420 Ph: (703) 840-4707 | Loudoun Community Health Center 11484 Washington Plz W Ste 300 Reston VA 20190-4342 Ph: (703) 443-2000 |
| NPI Number | 1174086938 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 04/09/2019 |
| Medicare PECOS PAC ID | 5193822930 |
|---|---|
| Medicare Enrollment ID | O20190919003271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174086938 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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