Organization
UNITED STATES COAST GUARD
Active
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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