Community Health Clinic PC
Organization Active NPI Rural Health Clinic/Center · Honaker, VA
NPI 1154345957 · NPPES record last updated Apr 30, 2008
Key facts
- NPI
- 1154345957
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 0101051181 (VA)
- Legal business name
- COMMUNITY HEALTH CLINIC PC
- Practice address
- 5705 Redbud Hwy
Honaker, VA 24641 - Phone
- (276) 873-6300
- Fax
- (276) 873-5859
- NPI assigned
- Jul 26, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY HEALTH CLINIC
Authorized official
- Name
- Dr. Faisal W Chaudhry, MD
- Title
- President
- Phone
- (276) 873-6300
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 12
-
Retha Michelle Blevins, FNP-C
-
Muna Faisal Chaudhry, M.D.
-
Marie H Green, NP
-
Jessica Dawn Jennings, NP-C
-
Catrina M Ratliff, FNP
-
Wendy N Rumley, FNP
-
Azhar Latif, MD
-
Angela M Lundy, NP
-
Amy Nicole Shortt, ACNP-AG
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Rural health clinic certification: CCN 493857
- Legal name
- COMMUNITY HEALTH CLINIC PC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 2, 1998
- Last certification
- Jul 30, 2024
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jul 1, 1997 in VA
- Enrollment address
- 5705 Red Bud Hwy
Honaker, VA 24260-1020
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Faisal W Chaudhry |
5% Or Greater Direct Ownership Interest | Jul 1, 1997 | 100% |
| Corporate Officer |
Jul 1, 1997 | 100% | |
| Operational/Managerial Control | Jul 1, 1997 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061213000051 | VA | Part a Provider - Rural Health Clinic | 5890769863 | Practice locations: Chantilly, VA; Honaker, VA; Richlands, VA |
National Provider Directory
- Tax ID family
- Community Health Clinic PC
- Part of
- Community Health Clinic PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 0101051181 | VA | Yes |
Addresses
Primary practice location
5705 Redbud Hwy
Honaker, VA 24641
Mailing address
PO Box 1020
Honaker, VA 24260-1020
Phone (276) 873-6300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5800811 | Medicaid | VA |
Other providers in Honaker, VA
- Barnhart Chiropractic & Wellness PLC
- Barnhart Chiropractic & Wellness PLC
- Eric K Barnhart
- Rebecca K Cantrell
- Faisal W Chaudhry
- Community Health Clinic, PC
- Lori Dye
- Family Preservation Services, Inc
- Nicholas Harmon
- Daniel Furl Hess
All providers in Honaker, VA · Rural Health Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.