Provider Demographics
NPI:1023340825
Name:BOYDTON COMMUNITY HEALTH FACILITY INC
Entity type:Organization
Organization Name:BOYDTON COMMUNITY HEALTH FACILITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-738-6102
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:390 WASHINGTON
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-0203
Mailing Address - Country:US
Mailing Address - Phone:434-738-6102
Mailing Address - Fax:434-738-6982
Practice Address - Street 1:390 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917-3415
Practice Address - Country:US
Practice Address - Phone:434-738-6102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010043263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4842022OtherNCPDP PROVIDER IDENTIFICATION NUMBER