Organization
CHASE CITY PRIMARY CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE TATUM JR. (VP OF FINANCE/CFO)
(434) 774-2400
Entity
Organization
Contact information
Practice address
200 E 5TH ST, CHASE CITY, VA 23924-1456
(434) 372-0900
(434) 372-8681
Mailing address
200 E 5TH ST, CHASE CITY, VA 23924-1456
(434) 372-0900
(434) 372-8681
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5903162
NC MEDICAID #
VA
Enumeration date
05/22/2006
Last updated
10/07/2008
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