Provider Demographics
NPI:1487089512
Name:LLOYD F. MOSS FREE CLINIC
Entity type:Organization
Organization Name:LLOYD F. MOSS FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DULANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1061
Mailing Address - Street 1:1301 SAM PERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8420
Mailing Address - Country:US
Mailing Address - Phone:540-741-1061
Mailing Address - Fax:540-741-1096
Practice Address - Street 1:1301 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8420
Practice Address - Country:US
Practice Address - Phone:540-741-1061
Practice Address - Fax:540-741-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024105931261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service