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Organization
CHASE CITY PRIMARY CARE CENTER, LLC
Active
Organization
CHASE CITY PRIMARY CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE TATUM JR. (VP OF FINANCE/CFO)
(434) 774-2400
Entity
Organization
Contact information
Practice address
200 E 5TH ST, CHASE CITY, VA 23924-1456
(434) 372-0900
(434) 372-8681
Mailing address
200 E 5TH ST, CHASE CITY, VA 23924-1456
(434) 372-0900
(434) 372-8681
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5903162
NC MEDICAID #
VA
Enumeration date
05/22/2006
Last updated
10/07/2008
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