Free Clinic of the New River Valley Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Pearisburg, VA
NPI 1306273149 · NPPES record last updated Oct 10, 2013
Key facts
- NPI
- 1306273149
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FREE CLINIC OF THE NEW RIVER VALLEY INC
- Practice address
- 219 Buchanan St
Pearisburg, VA 24134-1901 - Phone
- (540) 921-3502
- Fax
- (540) 382-3391
- NPI assigned
- Oct 10, 2013
- Organization subpart
- No
Authorized official
- Name
- Mrs. Michelle Brauns
- Title
- Executive Director
- Phone
- (540) 381-0820
Owners & managing parties with NPI records 2
-
Tracy J. Cohn, PH.D.
-
Anthony Ray Ramsey, FNP
Other NPIs with the same Medicare PAC ID 3
Practitioners 28
-
Peyton Randolph Bailey, PA-C
-
Kathryn Ballard, FNP-C
-
Janie Kelly, LPC
-
Rebecca King-Mallory, M.D.
-
Melisa Dawn Loving, FNP-C
-
Laura McCormick, LCSW
-
Allyson Yeatts, LCSW
-
Kimberly Carly Nicole Stevenson, FNP-BC
-
Morgan Paige Akers, FNP-BC
-
Melissa Worrell Dalton, WHNP
-
Daniel R Kelly, MD
-
Jennifer S Price, LCSW
-
Anthony Ray Ramsey, FNP
-
Cynthia Richards, LCSW
-
Charles Smith, NP
-
Sarah W Strang, NP
-
Raschid A Ghoorahoo, FNP
-
David J Roberts, MD
-
Megan Riggs, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491930
- Legal name
- FREE CLINIC OF THE NEW RIVER VALLEY INC
- Doing business as
- GILES CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 9, 2014
- Last certification
- Jan 9, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 7, 1979 in VA
- Enrollment address
- 239 Buchanan Street
Pearisburg, VA 24131-1901
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Matthew Pitonyak |
W-2 Managing Employee |
Sep 10, 2020 | |
| Operational/Managerial Control |
Sep 10, 2020 | ||
| Anthony Ramsey |
Corporate Director | Jan 6, 2014 | |
| Cathy McDowell |
Corporate Director | Jan 6, 2014 | |
| James Bohland |
Corporate Director | Jan 6, 2014 | |
| Kristi Eaton |
Corporate Director | Jan 6, 2014 | |
| Margot Thompson |
Corporate Director | Jan 6, 2014 | |
| Pat Hyer |
Corporate Director | Jan 6, 2014 | |
| Michelle Brauns |
Corporate Director |
Jan 6, 2014 | |
| W-2 Managing Employee |
Jan 6, 2014 | ||
| Tracy Cohn |
Corporate Director | May 1, 2012 | |
| Keith Finch |
Corporate Director | Jan 6, 2014 | |
| Patricia Gaudreau |
Corporate Director | Jan 6, 2014 | |
| John Bouldin |
Corporate Director | Jan 6, 2014 | |
| Amy Westmoreland |
Corporate Director | Jan 6, 2014 | |
| Lynne Knox |
Corporate Director | Jan 6, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140109000945 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 5294963666 | Practice locations: Pearisburg, VA |
| O20140414001357 | VA | Part B Supplier - Clinic/Group Practice | 5294963666 |
Receives reassigned benefits from 24 practitioners Practice locations: Pearisburg, VA |
National Provider Directory
Locations
209 Roanoke St
Ste 4
Christiansburg, VA 24073
Phone (540) 381-0820
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | VA | Yes |
Addresses
Primary practice location
219 Buchanan St
Pearisburg, VA 24134-1901
Mailing address
215 Roanoke St
Christiansburg, VA 24073-3025
Phone (540) 381-0820
Other names
- Giles Clinic
Other providers in Pearisburg, VA
- Empower2000, Inc
- Hannah Evans
- Tiffany Lea Farmer
- John Randall Finch
- Richard S Frazier
- Free Clinic of the New River Valley, Inc
- Ethan Ray Freeborn
- Kate Geary
- Giles County Public Schools
- Giles Health & Family Center
All providers in Pearisburg, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2013. 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.