Organization
WASHINGTON SQUARE CLINIC INC
Active
Organization
WASHINGTON SQUARE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TUSHAR G PATEL MD (PRESIDENT WASHINGTON SQUARE CLINIC)
(276) 964-6711
Entity
Organization
Contact information
Practice address
3150 CLINCH ST, RICHLANDS, VA 24641
(276) 964-6711
(276) 964-2240
Mailing address
3150 CLINCH ST, RICHLANDS, VA 24641
(276) 964-6711
(276) 964-2240
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709083
MTN STATE BC
—
05
—
006034951
—
VA
05
—
007330146
—
VA
01
—
027996700
FEDERAL BLACK LUNG
—
01
—
049115
BCBS
VA
01
—
049118
BLUE CROSS BLUE SHIELD
—
01
—
049120
BLUE CROSS BLUE SHIELD
—
01
—
068118
BLUE CROSS BLUE SHIELD
—
01
—
068119
BLUE CROSS BLUE SHIELD
—
01
—
137286
BLUE CROSS BLUE SHIELD
—
01
—
1499361
UMWA
—
01
—
5545395
AETNA
—
01
—
CG0014
RAILROAD MEDICARE GROUP
—
Enumeration date
11/01/2006
Last updated
05/22/2008
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