1245765544 NPI number — DR TERRY SINCLAIR HEALTH CLINIC INC

Table of content: (NPI 1245765544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245765544 NPI number — DR TERRY SINCLAIR HEALTH CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR TERRY SINCLAIR HEALTH CLINIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FREE MEDICAL CLINIC OF NORTHERN SHENANDOAH VALLEY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245765544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 N CAMERON ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-1680
Provider Business Mailing Address Fax Number:
540-662-5321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N CAMERON ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-536-1680
Provider Business Practice Location Address Fax Number:
540-662-5321
Provider Enumeration Date:
04/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLURE
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
540-536-1681

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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