Organization
UNITED STATES COAST GUARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH RAY MITCHELL JR. M.A. (HEALTH SERVICE TECHNICIAN)
(757) 856-2230
Entity
Organization
Contact information
Practice address
30 URBANNA CREEK CT, SALUDA, VA 23149-3075
(804) 758-1631
Mailing address
30 URBANNA CREEK CT, SALUDA, VA 23149-3075
(804) 758-1631
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
24720000X
VA
Other
Enumeration date
10/05/2006
Last updated
08/22/2020
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