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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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