Organization
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA FUTRELL (CHIEF EXECUTIVE OFFICER)
(757) 591-0643
Entity
Organization
Contact information
Practice address
1033 28TH ST, 2ND FLOOR, NEWPORT NEWS, VA 23607-4233
(757) 591-0643
(757) 591-0682
Mailing address
4714 MARSHALL AVE, NEWPORT NEWS, VA 23607-2247
(757) 591-0643
(757) 591-0682
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7687648
—
VA
Enumeration date
01/24/2006
Last updated
10/18/2012
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