| Stony Creek Community Health Center | |
|
12454 Hartley St Stony Creek VA 23882-3302 | |
| (434) 246-6100 | |
| (434) 246-6614 |
| Full Name | Stony Creek Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12454 Hartley St, Stony Creek, Virginia |
| Authorized Official Name and Position | Lucy J Elder (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4342463501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stony Creek Community Health Center 12454 Hartley St Stony Creek VA 23882-3302 Ph: (434) 246-6100 | Stony Creek Community Health Center 12454 Hartley St Stony Creek VA 23882-3302 Ph: (434) 246-6100 |
| NPI Number | 1376515031 |
|---|---|
| Provider Enumeration Date | 02/06/2006 |
| Last Update Date | 05/08/2020 |
| Medicare PECOS PAC ID | 5395710057 |
|---|---|
| Medicare Enrollment ID | O20040827000163 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376515031 | NPI | - | NPPES |
| 007636407 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Malalai Davenport Azmi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891766549 PECOS PAC ID: 8729022553 Enrollment ID: I20050614001193 |
| Provider Name | Michael D Matherlee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164493813 PECOS PAC ID: 5496886160 Enrollment ID: I20100623000978 |