Organization
FEDERAL BUREAU PRISONS, FCC PETERSBURG
Active
Organization
FEDERAL BUREAU PRISONS, FCC PETERSBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ABDELOUAHAB BENMANSOUR RN (HSA)
(804) 504-7200
Entity
Organization
Contact information
Practice address
1060 RIVER RD, PETERSBURG, VA 23801-1398
(804) 504-7200
(804) 504-7225
Mailing address
PO BOX 90026, PETERSBURG, VA 23804-9000
(804) 504-7200
(804) 504-7225
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
MD052885L
PA
Other
Enumeration date
12/02/2011
Last updated
04/22/2022
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